Application for National Louis Alumni Board

First Name: *

Last Name: *

Maiden Name or repeat last if same: *

Class Year: *

Email Address: *

Cell or Home Phone Number: *

Home / Mailing Address: *

City: *

State *

Zip Code: *

Company Name:

Title:

Work Address:

Work City:

Work State

Work Zip:

Work Phone:

What activities were you most involved in during your time at NLU?

What skills and/or experience would you bring to benefit the operations of the Alumni Board?

Please share faculty or staff member(s) who was most influential to you and briefly describe how his/her influence affected you:

Recommended to apply by?/Learned about the Alumni Board from...? *

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