Kwantlen Polytechnic University Alumni Association (KPUAA) Board Candidate Form
Date:
Kwantlen Polytechnic University Alumni Association (KPUAA) Board Candidate Form
APPLICANT NAME:Title: / First Name: / Last Name:
EDUCATION INFORMATION:
Kwantlen Credential: / Year:
Student Number:
Other Credential: / Year:
School:
Other Credential: / Year:
School:
CONTACT INFORMATION:
Home Address:
City: / Prov: / Postal Code:
Home Phone: / Mobile Phone
Personal Email:
EMPLOYMENT INFORMATION:
Employer Name:
Title:
Business Phone: / Work Email:
MEMBERSHIPS IN PROFESSIONAL ORGANIZATIONS:
Organization Name:
Organization Name
PREVIOUS BOARD AND/OR VOLUNTEER EXPERIENCE
Organization Name:
Position: / Term of Service:
Organization Name:
Position: / Term of Service: / Term of Service:
ALUMNI INFORMATION
Please describe your past involvement with Kwantlen:
Please describe your interest in joining the Kwantlen Alumni Association Board of Directors:
The Kwantlen University Alumni Association (KPUAA) has responsibilities as outlined in the BC Societies Act, University Act, and its constitution and bylaws. The focus of the board will be to set direction for the KPUAA in collaboration with the Executive Director, determining association goals and expected results, taking into consideration available resources, and monitoring the performance of the board and of the association as a whole. All successful candidates who are appointed to the board are expected to sit on at least two committees and attend all board meetings. A detailed terms of reference is available by emailing . Please specify below, which committees may be of interest to you.
Alumni
Engagement / Tributes/awards
Governance / Other (ad-hoc)
Risk Management
NOMINATOR NAME:
Title: / First Name: / Last Name:
EDUCATION INFORMATION:
Kwantlen Credential: / Year:
Student Number:
CONTACT INFORMATION:
Home Address:
City: / Prov: / Postal Code:
Home Phone: / Mobile Phone
Personal Email:
Relationship to Nominee
CANDIDATE STATEMENT:
I understand that the Alumni Association and Kwantlen Polytechnic University have an obligation to verify reference information with respect to all candidates for potential appointments, including myself.
By signing below, I authorize the Alumni Association and Kwantlen Polytechnic University to verify or obtain personal information about me directly from me, from organizations or references referred to in this application for the purpose of evaluating my suitability for appointment to the Board of Directors for the Alumni Association.
If I am a successful candidate, I allow my name to stand for nomination for the KPUAA Board of Directors election taking place in this calendar year.
Iagree that if I am appointed for a position on the Board of Directors, the Alumni Association and Kwantlen Polytechnic University may publish a biography of me that contains information provided in this application.
Signature: / ______/ Date: / ______
Please submit the following information with your application:
Résumé outlining education, occupation, volunteer experience, professional interests and achievements. (Required) / Executive
Biography (150 words or less) to be used on the website for the purpose of this election if you are a successful candidate. (Required) / Risk Management
Any other supporting documentation. (Optional)
/ A professional looking photo (headshot) of yourself that will be uploaded with your bio for the online election. If we do not receive a photo from you, just your bio will be uploaded.
Any other supporting documentation. (Optional)Supporting documents must not exceed 5 pages. / Any other supporting documentation.
Please email your completed form and any supporting documentation to .