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Northern Illinois University

Executive Club

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Executive Club Application

Please complete and submit the following online application. If you have any questions regarding this form or the Executive Club, please contact businessalumni@niu.edu.

PERSONAL INFORMATION:
First Name:	M.I.: Last Name:
"Nickname":
Home Address:
City:
State/Province:	Postal Code:
Country:
Home Phone:
Email:

EDUCATION:
1st Degree - Institution	Degree	Year	Major
2nd Degree - Institution	Degree	Year	Major
3rd Degree - Institution	Degree	Year	Major

AREAS OF EXPERTISE:

Other
Would you be interested in speaking with NIU students/staff in a classroom? Yes No

COMPANY INFORMATION:
Company Name:
Company Description:
Company Web Address:
Position Title:
Does your position include employee management? Yes No
If Yes, how many employees?
Work Address:
City:
State/Province:	Postal Code:
Country:
Work Phone:
Fax:
Assistant Info:

Paste a plain text version of your resume or bio in the box below.
RESUME/BIO:

Briefly describe your interest to join the NIU Executive Club.
STATEMENT OF INTEREST:


HOW DID YOU HEAR ABOUT THE NIU EXECUTIVE CLUB?
Please type the letters you see in the box to the right: