BOG ADVISORY BOARD APPLICATION
Name __________________________________________________
Class Status: FR SO JR S
GPA: ________
Number of Credits Earned:___________________
Local Address__________________________________________________________
Phone Number_____________________ Email Address_______________________
Expected Graduation Date__________________________
List all campus organizations/activities that you are currently a part of and any
positions that you have held.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
On a separate sheet of paper please provide validation of that you have participated
in the above organizations/activities.
On a separate sheet of paper please answer the following question: Why should you
be considered as mentor for the Board of Governor’s Advisory Board Member?
On a separate sheet of paper please provide one letter of recommendation from a
Bloomsburg University professor, faculty, or staff member. (Recommendations
cannot come from employees of the Office of Diversity and Retention.
Date _____________________________
Name (Print)
___________________________________
Signature
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