Concerned Stakeholder Contact Form

Concerned Stakeholder Form

Please enter your information below so that we may keep you informed.
Full Name: *

First Name Last Name
Title: *
Contact Number *

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Country:
E-mail: *
example@example.com
School/College
Graduation Year:
Affiliation to Howard University *
Occupation (if retired, choose your primary former career): *
Are you a member of HUAA? *

Yes No
What is the best way to reach you? *
Have you ever served in a student government position while attending Howard University? *

Yes No
If so, please note organization, position, and year
Have you ever served on the Howard University Board of Trustees? *

Yes No
If so, please note position, committees served, and years served
Please note Concerned Stakeholders committees* upon which you would like to serve:

Alumni Independence** Communications/Social Media Research
*Please see descriptions of all committees here.

**If you would like to join one of the Alumni Independence subcommittees, please use this form. Thank you!!
Comment and Questions:
Source *
Should be Empty:

Concerned Stakeholder Form