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Name: _____________________________________ Date: ______________________
Graduating Name if different from above: _____________________________________
Address: _______________________________________________________________
City:_______________________________ State: ________ Zip: ______________
Country: ___________________________ Postal Code: _______________________
Phone #: __________________________ Work #: __________________________
E-mail Address: _________________________________________________________
Year(s) Graduated: ____________ Degree(s): ________________________________
Current Employment
Company name: _________________________________________________________
Position: _______________________________________________________________
Job Responsibilities &/or Accomplishments:____________________________________
_______________________________________________________________________
_______________________________________________________________________
Why do you want to serve on the Board? _____________________________________
______________________________________________________________________
______________________________________________________________________
What committee(s) would you like to serve on (Alumni Relations, Finance, International Relations, Nominations, Student Relations, University Relations)? ______________________________________________________________________
Please attach a copy of your resume.
Applicants to the Board of Directors must be a member of the Florida Tech Alumni Association.
Positions on the Board are for a three year term and applicants should carefully read the Responsibilities and Expectations of Alumni Board Members and confirm their willingness to fulfill these obligations. We look forward to your participation.
Please mail your application to:
Florida Institute of Technology
Office of Alumni Affairs
150 W. University Blvd.
Melbourne, FL 32901
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