NOMINATION INFORMATION FORM

BOARD OF DIRECTORS

CLARION UNIVERSITY ALUMNI ASSOCIATION

Personal Information

Name                                                                                                                                                  

Address                                                                                                                                               

City                                                                                          State                 Zip                              

Home Phone     (           )                                   Home E-mail                                                               

Home Fax    (           )                                       Soc. Sec. No.                                                              

Academic Information

Academic Major                                                          Year(s) of Graduation                                       

Degree(s) Received                                                                                                                             

College (Edu. & Human Svcs; Arts & Sciences; business; etc.)                                                                                                                                                                                                                          

Additional Education Information

Additional Education (other than undergraduate degree)                                                                                                                                                                                                                                                                                                                                                                                                  

Business Information

Current occupation                                                                                                                               

Company name/address                                                                                                                                                                                                                                                                                    

City                                                                                          State                 Zip                              

Business Phone   (         )                                                           Ext.                                                     

Business Fax  (          )                                      Business E-Mail                                                          

Employment Summary

  Years                         Position                                     Firm

Family Information

If married, please indicate your spouse’s name                                                                                       

If married to a CU grad, please indicate graduation year(s)                                                                     

Spouses degree(s)/major(s)                                                                                                                   

If you have children, please indicate their names and dates of birth                                                                                                                                                                                                                      

Board Involvement

Would you be able to attend approx. five meetings a year on campus (usu. Tuesday evenings)                                                                                                                                                                              

Are you able and willing to pay your own transportation and lodging expenses?                                                                                                                                                                                                    

Have you been active in alumni efforts on behalf of Clarion University? If so, please proved a brief explanation                                                                                                                                                                                                                                                                                                                                                                                                                                                                 

If you are active in your community, please indicate major interest or areas of participation                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           

Additional comments or information                                                                                                                                                                                                                                                                                                                                                                                                                         

Please list general circulation newspapers in your area                                                                                                                                                                                                                               

Signature                                                                                                                                 Date

*Please return to:  Center for Advancement, Clarion University, 840 Wood Street, Clarion, PA  16214  Attn:  Theresa Martin