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GOLD Council | Intake Form
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GOLD Council | Intake Form
Contact Information
Email
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Inquiry / Question
Select the reason for your Inquiry
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General Inquiry / Question
Young Alumni Feedback
Event / Engagement Idea
Official GOLD Council Member Application
Name
*
First
Last
Inquiry / Question Subject
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Inquiry / Question
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Young Alumni Feedback
Name
*
First
Last
Class Year (Please include your graduate year if applicable)
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Feedback Type
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GOLD Council Feedback
Clark University Feedback
Clark Alumni & Friends Feedback
Feedback Subject
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Feedback
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Event / Engagement Idea
Name
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First
Last
Idea / Initiative Type
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Event
Engagement
Programming
Other
Other
Idea / Initiative Subject
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Idea / Initiative Description
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Official GOLD Council Member Application
Name
*
First
Last
Class Year (Pease include your graduate year if applicable)
*
Major(s) / Minor(s)
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Demographic Questions
The GOLD Council is committed to enhancing Clark’s efforts toward diversity, equity, and inclusion. Please answer the following questions to help us ensure that the GOLD Council represents the larger Clark alumni community.
Gender
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Male
Female
Prefer not to answer
Other
Other
Ethnicity
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Caucasian
African-American
Latino or Hispanic
Asian
Native American
Native Hawaiian or Pacific Islander
Two or More
Other / Unknown
Prefer not to say
Other
Other
Country
*
Choose Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saint Martin
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
City
*
City
GOLD Council Questions
Please list all of your involvement during your time at Clark. These could include leadership positions, clubs, organizations, part-time jobs, etc.
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In no more than 250 words, why do you want to join the GOLD Council? *
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In no more than 250 words, what are your top 3 goals for the GOLD Council? *
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What is your potential availability to dedicate to the GOLD Council (e.g. 4-5 hours/month)? *
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We have 3 different committees - the Communications Committee, The Philanthropy Committee, and the Student and Young Alumni Committee. Would you be interested in joining a committee? (Please refer to the PDF to read more about the committees)
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Yes
No
Maybe
Other
Other
Last question! Please tell us about your favorite Clark memory.
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Anything you would like to share with Clark University?
Confidentiality Agreement
I, the undersigned, acknowledge that, in connection with my provision of volunteer services to Clark University (the University) and my other associations with the University, I have had, and will have, access to Confidential Information, as defined in this Agreement. For purposes of this Agreement, Confidential Information shall mean any and all information of the University that is not generally available in the public domain (other than as a result of the breach by me or any other person or entity of an obligation to the University) and shall also include any information received by the University from any third party with any understanding, express or implied, that the information would not be disclosed. As a condition of my engagement to provide volunteer services to the University, I agree to keep secret all Confidential Information and not to disclose or copy it or remove it from the premises of the University, except with the prior express written approval of a duly authorized officer of the University. I agree also that I will use Confidential Information only for the benefit of the University and only as required for the proper performance of my services to the University. Further, I agree that all Confidential Information which I create or to which I have access as a result of my provision of services to, and other associations with, the University is and shall remain the sole and exclusive property of the University. I will return to the University immediately upon conclusion of my services, and at such other times as may be specified by a duly authorized officer of the University, all confidential Information and all other property of the University then in my possession or control; provided, however, that, if Confidential Information is on electronic media (e.g., a computer hard drive), I will provide a copy to the University on electronic media (e.g., a thumb drive or other media) and delete and overwrite all other electronic media copies thereof. I agree that my obligations under this Agreement shall continue to apply after the conclusion of my services to the University, regardless of the reason for such termination. Intending to be legally bound, I have signed this Agreement as of the date indicated below. Please read the content above before selecting the checkbox below.
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