Campus Compact Member Information
Please complete and forward this to the Office of Oregon Campus Compact. Please call 503-406-3575 with questions. Thank you!
College/University Name ______
Address ______
City, State, Zip______
Main Phone #______
Date Joined ______Today’s Date ______
Number of Full-Time Equivalent Undergraduate Students______
President President’s Staff Contact
Salutation (Mr., Ms., Dr.) ______Salutation (Mr., Ms., Dr.) ______
Name ______Name ______
Title ______Title ______
Office ______Office ______
Campus Address ______Campus Address______
______
Telephone: ______Telephone: ______
Fax: ______Fax: ______
E-Mail:______E-Mail: ______
Does the president want to receive ORCC’s Add this person to ORCC’s monthly
monthly e-newsletter? Yes No e-newsletter recipient list? Yes No
Community Service Contact Faculty Service Learning Contact
Salutation (Mr., Ms., Dr.) ______Salutation (Mr., Ms., Dr.) ______
Name ______Name ______
Title ______Title ______
Office ______Office ______
Campus Address ______Campus Address ______
______
Telephone: ______Telephone: ______
Fax: ______Fax: ______
E-Mail: ______E-Mail: ______
Add this person to e-newsletter list? Yes No Add this person to e-newsletter list? Yes No
Chief Academic Officer Contact Chief Librarian
Salutation (Mr., Ms., Dr.) ______Salutation (Mr., Ms., Dr.) ______
Name ______Name ______
Title ______Title ______
Office ______Office ______
Campus Address ______Campus Address ______
______
Telephone: ______Telephone: ______
Fax: ______Fax: ______
E-Mail: ______E-Mail: ______
Add this person to e-newsletter list? Yes No Add this person to e-newsletter list? Yes No
Government Relations Contact Press/Public Information Contact
Salutation (Mr., Ms., Dr.) ______Salutation (Mr., Ms., Dr.) ______
Name ______Name ______
Title ______Title ______
Office ______Office ______
Campus Address ______Campus Address ______
______
Telephone: ______Telephone: ______
Fax: ______Fax: ______
E-Mail: ______E-Mail: ______
Add this person to e-newsletter list? Yes No Add this person to e-newsletter list? Yes No
Student Affairs/Services Contact Student Leadership Contact (if applicable)
Salutation (Mr., Ms., Dr.) ______Salutation (Mr., Ms., Dr.) ______
Name ______Name ______
Title ______Title ______
Office ______Office ______
Campus Address ______Campus Address ______
______
Telephone: ______Telephone: ______
Fax: ______Fax: ______
E-Mail: ______E-Mail: ______
Add this person to e-newsletter list? Yes No Add this person to e-newsletter list? Yes No
Institutional Research Contact Grants Office Contact
Salutation (Mr., Ms., Dr.) ______Salutation (Mr., Ms., Dr.) ______
Name ______Name ______
Title ______Title ______
Office ______Office ______
Campus Address ______Campus Address ______
______
Telephone: ______Telephone: ______
Fax: ______Fax: ______
Add this person to e-newsletter list? Yes No Add this person to e-newsletter list? Yes No
Cooperative Education Contact Literacy/Mentoring Program Contact
Salutation (Mr., Ms., Dr.) ______Salutation (Mr., Mrs., Dr.) ______
Name ______Name ______
Title ______Title ______
Office ______Office ______
Campus Address ______Campus Address ______
______
Telephone: ______Telephone: ______
Fax: ______Fax: ______
Add this person to e-newsletter list? Yes No Add this person to e-newsletter list? Yes No
Thank You!
Oregon Campus Compact ▪ 620 SW 5th Avenue, Ste. 800 Portland, OR ▪ 97204
503-406-3575 ▪ Fax: 503-406-3568 ▪ www.oregoncampuscompact.org