Welcome AlumniAlumni Leadership CouncilALC Application Form Alumni Leadership Council Application Form Step 1 of 4 25% Demographic InformationName* First Middle Last Student ID(optional)Mailing Address* Street Address Address Line 2 City State ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Phone*Date of Birth MM slash DD slash YYYY For administrative purposes.Do you consent to a background check?* Yes No **Consent is required to be in consideration for a spot on the Alumni Leadership Council**Are you willing to participate in marketing initiatives for Excelsior University?* Yes No Education & OccupationDo you currently work for Excelsior University as either faculty or staff?* Yes No Highest Excelsior University Degree Earned*(For example: Master in Business Administration) Excelsior University Graduation Month, Year*Of highest degree earned from Excelsior (For Example: October, 2012)Other Degree(s) and Year(s) earned at Excelsior University(optional)Degree(s) Earned Elsewhere, Year(s) and Granting Institution(s)(optional)Current Occupation*Current Employer*Excelsior Alumni Engagement InformationAre you an Alumni Ambassador?* Yes No Do you follow Excelsior on social media?* Yes No Please list the social media platforms you follow, like, etc.,* Select All LinkedIn Facebook Excelsior Connects Instagram TikTok YouTube X (formerly, Twitter) Communities Hub Are you a registered user on Excelsior Connects?* Yes No LinkedIn Profile Link (please provide a shareable LinkedIn profile link. It is beneficial to have Excelsior listed on your profile.)Have you ever made a financial contribution to Excelsior?* Yes No Council CriteriaAre you willing to travel to Albany, NY in July of each year of your terms to attend the summer council meeting held in conjunction with Commencement? (Travel costs are paid by the University).* Yes No If no, why not?Are you able to participate in teleconferences throughout the year?* Yes No If no, why not?Able to participate in virtual meetings via Zoom and receive and send info via computer and internet?* Yes No If no, why not?Council members are required to make a financial contribution to Excelsior each year of their term in support of the annual campaign and institutional fundraising initiatives. Please describe your support of the annual alumni campaign and/or insitutional fundraising initiatives since your graduation.* Personal and Community AchievementsNumber of books, reports, articles of note authored***IF NONE, PLEASE PUT N/A. Please list the following for each publication: name of the publication, name of the publisher, your role, and year published.***IF NONE, PLEASE PUT N/A. Number of Professional Affiliations***IF NONE, PLEASE PUT N/A. Please list the following for each affiliation: name of organization, dates of membership, and leadership position held.***IF NONE, PLEASE PUT N/A. Number of Trade or Industry Memberships***IF NONE, PLEASE PUT N/A. Please list the following for each membership: organization name, organization address; and name of organization's publication.***IF NONE, PLEASE PUT N/A. Are you a leader in your local or regional community?***IF NONE, PLEASE PUT N/A. Please list the following for each community organization: name of organization, dates of membership, and leadership position held.***IF NONE, PLEASE PUT N/A. Please provide a brief Statement of Interest and Rationale for Selection - Why do you want to join the Alumni Leadership Council?*Why do you feel that you are uniquely qualified to join the Alumni Leadership Council?*Please Add Any Additional information You Would Like to Share with the Nominations CommitteeFor Example: ways you can make a positive impact on the alumni community, ways you've remained engaged as an alum, etc., CAPTCHA
