2023 National Convention Committee Application
SUBMISSION DEADLINE: MONDAY, JANUARY 9th
Full Name
*
First Name
Last Name
E-mail
*
Please provide the email best to communicate with you. This will also be used to set up your account with Microsoft TEAMs
Phone Number
*
Please enter a valid phone number.
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Please list any Special Needs, ADA requirements, food allergies, etc:
*
*If none, enter "N/A"
Select your Polo size
*
X-Small
Small
Medium
Large
X-Large
2XL
3XL
Other
Member Category
*
Undergraduate
Graduate
Professional
Advisor
Lifetime Member
SHPE ID Number
*
Active Membership is Required. Please visit shpeconnect.org to view your membership status
What SHPE Region do you live in?
*
Region 1
Region 2
Region 3
Region 4
Region 5
Region 6
Region 7
SHPE Chapter Name
*
Please write At-Large member if not associated with a specific chapter
Employer/ School or University
*
Job Title/ or Student grade level
*
Headshot Upload:
Browse Files
Drag and drop files here
Choose a file
*If selected, we will upload the committee roster to the convention website
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Have you served on the committee before?
*
Yes
No
How many years?
*
Select the committee(s) you would like to be considered for:
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Advisor Committee
Community College Committee
Competition - Academic Olympiad
Competition- Cyber Security
Competition- Design
Competition- Engineering Science Symposium
Competition Member - Graduate Thesis
Competition Member - No preference
Convention Readiness Committee
Corporate Relations Committee
Corporate Tours Committee
Entrepreneurship Committee
Graduate Committee
Diversity & Inclusion Committee
Marketing Committee
On-Site Support Committee
Professionals Committee
SHPEtina Committee
Signage Committee
Special Events Committee
STAR Awards Committee
Surveys Committee
TechTalks Committee
Workshop Support Committee
No Preference
Committee Descriptions:
Tell us why you are a great fit for this role? (What background or skills do you have to support the role you are interested in)
*
*If you chose multiple committees, please indicate your preference of order here
Please read and review the SHPE National Convention Guidelines
Signature
*
Todays Date
*
-
Month
-
Day
Year
Date
If you have any questions or concerns, please contact Alejandra Baez at events@shpe.org.
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