Clemson Black Alumni Council (CBAC) Nomination Form

Thank you for your interest in serving on the Clemson Black Alumni Council.

CBAC Officer Nomination Form

Please indicate for which position(s) you are interested in being considered*
- CBAC President
- CBAC President-Elect
First Name*
Middle Name
Maiden Name
Last Name*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Preferred Phone*
Email*
Year of Graduation*
Clemson Univ. Major*
Hometown While a Student
Current Occupation*
Name of Employer*
Business Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Type of Business
Additional Education
College/University Name Degree/Major Years Attended
Please provide information about activities you participated in while you were a stuent at Clemson University
Group/Club Name Years Involved Positions Held (leadership, member, etc.)
Please provide information about any professional activities you have been involved in during or since you were a student at Clemson University
Group Name Years Involved Positions Held (officer, member, etc.)
Please provide information on any involvement with the Clemson Alumni Association during your time at Clemson University or since your graduation from Clemson
Acitvity or Group Name Years Involved Positions Held (officer, member, etc.)
Please share any additional Clemson involvement that may be helpful to the nominating committee:
Please provide information on other social or civic activities in which you have participated
Group Name Years Involved Positions Held (officer, member, etc.)
What strengths or particular skills make you qualified for a position of leadership?*
Are there any special circumstances that exist to make you uniquely qualified for leadership at this time?
Have you previously served in an organizational leadership capacity? If so, please identify the organization and explain your leadership role.
Please list any additional leadership experience you possess.
Please share any other information that may be helpful to the nominating committee in reviewing your nomination form.
Are you aware of the responsibilities and time commitment associated with the positions you have selected?*
- Yes
- No
Please provide the names and contact information of three references (at least one professional and one personal)*
Pesonal or Professional Name of Reference Address Phone Email
Please attach a current resume or a curriculum vita which includes professional and service activities
Drop files here or

Max. file size: 50 MB.
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Group/Club Name	Years Involved	Positions Held (leadership, member, etc.)

Group Name	Years Involved	Positions Held (officer, member, etc.)

Acitvity or Group Name	Years Involved	Positions Held (officer, member, etc.)

College/University Name	Degree/Major	Years Attended

Pesonal or Professional	Name of Reference	Address	Phone	Email