Alumni Nomination to the Board of Directors

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