» University Advancement
Because you are being considered for membership on the Northwest Foundation Board of Directors, we ask that you please complete the following information to be shared with the Board when reviewing potential members.
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*Full Name:
*Current City and State of Residence:
*Preferred Email Address:
*Preferred Phone Number:
*Street Address:
*City:
*State: - Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
*Zip Code:
*Birthday (month/day):
Hometown:
Spouse/Partner Name:
Children (include names and ages):
*Academic degrees/majors, graduation years, institutions:
Community Involvement:
Philanthropic Interests:
Service on Other Boards (past and present):
Current Job Title:
Employer Name:
Employer Address:
Employment Dates:
Business Email:
Business Phone:
*Career History (include past employers and job titles):
Areas of Expertise:
Activities or organizations involved in while attending Northwest (if applicable):
Current Engagement with Northwest:
*What interests you about serving on the Northwest Foundation Board of Directors:
Give Now | Office of University Advancement | 660.562.1248 | advance@nwmissouri.edu
