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NOMINATIONFORMWEB - NOMINATION FORM - Conv and BOR

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NOMINATION FORM FOR CONVOCATION OR BOARD OF REGENTS
(PLEASE PRINT CLEARLY)
Each Caucus has different processes for recruiting new Convocators who can strategically connect the
University to the Lutheran church and larger faith community. The Convocation is seeking representatives
from full communion partner churches, multi-faith communities, and underrepresented populations in
commitment to the strategic plan of the University.
Connection to CLU and/or PLTS (if applicable):
Qualifications:
Recommended by: ____________________________________________________
Phone: __________________________ Email: _____________________________
Date: ___________________________
Return by email to:
Caeli Koizumi at ckoizumi@callutheran.edu
Or by mail to: Mission and Identity, 60 W. Olsen Rd., #7700, Thousand Oaks, CA 91360
For questions, please email Caeli Koizumi, or call the Office of Mission and Identity at (805) 493-3589
Nominee Name: ____________________________________________________________
Address: _________________________________________________________
State: ______________ Zip: ____________ ____________
Telephone (business): ______________________(home): ____________________
Email:____________________________________________________________
Nomination for: Convocator Regent
Faith Tradition: _____________________________________________________________
Place of Worship: ___________________________________________________
Race/Ethnicity: _____________________________________________________
Gender Identity: _____________________________________________________
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Completed 13 February 2020

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