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