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College of Health Professions
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Advisory Board Member Profile Form

Advisory Board Member Profile Form

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- Alumni & Friends
  - Advisory Board Member Profile Form
  - Graduate Exit Survey
  - Keep in Touch
    - Thank You!

Name * Required
First Last
Title (if applicable)
Company Name * Required
Work Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Day Phone * Required
Fax Phone
Mobile Phone
Email Address * Required
Home Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Evening Phone
Birthdate (Month and Day Only) * Required
The best way to communicate with the program is by (Please check one) * Required
- Email
- Phone
- Letter
Please indicate the experience and talents you bring to the Advisory Board. (Please check all that apply): * Required
- Professional Relationship
- Management
- Investments
- Public Relations/Marketing
- Real Estate
- Construction
- Strategic Planning
- Legal Affairs
- Budget/Finance
- Fundraising
- Government Relations
- Other
You marked "Other" on the last question. Please provide more details in the space provided. * Required
What is your interest in serving on the board? (Please check all that apply) * Required
- Support of CHP
- Professional Connections
- CHP Alumnus
- Interest in Education
- Improving Opportunities for Allied Health Professionals
- Increasing Awareness of Allied Health Professionals
- Other
You marked "Other" on the last question. Please provide more details in the space provided. * Required
On what other boards or councils do you serve?
Organization
Date of Term Expiration
Month
Day
Year
Organization
Date of Term Expiration
Month
Day
Year
Organization
Date of Term Expiration
Month
Day
Year
Organization
Date of Term Expiration
Month
Day
Year
Organization
Date of Term Expiration
Month
Day
Year

Home
- Alumni & Friends
  - Advisory Board Member Profile Form
  - Graduate Exit Survey
  - Keep in Touch
    - Thank You!

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4301 West Markham St., Slot #619
Little Rock, AR 72205
(501) 686-5730
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