Concerned Stakeholder Contact Form

Full Name:*

First NameLast Name

Title:*

Contact Number*

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / 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?*

YesNo

What is the best way to reach you?*

Have you ever served in a student government position while attending Howard University?*

YesNo

If so, please note organization, position, and year

Have you ever served on the Howard University Board of Trustees?*

YesNo

If so, please note position, committees served, and years served

Please note Concerned Stakeholders committees upon which you would like to serve:

Comment and Questions:

Concerned Stakeholder Form