GOLD Council | Intake Form | Alumni

Contact Information

Email*

Inquiry / Question

Select the reason for your Inquiry*

Name*

First Last

Inquiry / Question Subject*

Inquiry / Question*

Young Alumni Feedback

Name*

First Last

Class Year (Please include your graduate year if applicable)*

Feedback Type*

GOLD Council Feedback
Clark University Feedback
Clark Alumni & Friends Feedback

Feedback Subject*

Feedback*

Event / Engagement Idea

Name*

First Last

Idea / Initiative Type*

Event
Engagement
Programming
OtherOther

Idea / Initiative Subject*

Idea / Initiative Description*

Official GOLD Council Member Application

Name*

First Last

Class Year (Pease include your graduate year if applicable)*

Major(s) / Minor(s)*

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*

Male
Female
Prefer not to answer
OtherOther

Ethnicity*

Country*

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.*

In no more than 250 words, why do you want to join the GOLD Council? **

In no more than 250 words, what are your top 3 goals for the GOLD Council? **

What is your potential availability to dedicate to the GOLD Council (e.g. 4-5 hours/month)? **

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)*

Yes
No
Maybe
OtherOther

Last question! Please tell us about your favorite Clark memory.*

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.

Please read the content above before selecting the checkbox below.*

I certify that I have read the statement above and I fully understand its content. I am aware that this is a photo release of liability and a contract and I sign it of my own free will.

Acknowledgement of the statement represents your agreement and understanding of the Confidentiality Agreement.

Participant's Electronic Signature*

Acknowledgement of the statement represents your agreement and understanding of the agreement

Date of Signature*

Biographical Information

Name*

First Last

Class Year*

Email*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title

Organization

LinkedIn Profile

Volunteer Interests

What sorts of volunteer opportunities are you interested in? Select all that apply:*

Select All
Event planning and promotion
Writing/newsletter content
Fundraising help/advocacy
Panel discussions
Student/club engagement/mentorship (encourage them on ClarkCONNECT)
Wherever I'm needed!
Other (please specify):

Other Volunteer Interest

Would you be interested in hosting your own alumni meet-up in your city?*

Yes
No
Maybe

Comments

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