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CA/RR Interest Form
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Class Agent/ Regional Representative Interest Form
Biographic Information
Prefix
Admiral
Bishop
Capt.
Col.
Dcn.
Dr.
Hon.
Judge
Lt.
Lt. Col.
Maj.
Mayor
Mr.
Mrs.
Ms.
Pastor
President
Prof.
Rear Admiral
Rev.
Sen.
Very Rev.
First Name
Middle Name
Last Name
Maiden Name (if applicable)
Preferred Class Year
Banner ID
Contact Information
Personal Email
Cell Phone Number
Your mailing address
Country
Street
City
Region
Postal Code
Career Details
Company
Job Title
Linked in Profile
Industry
Are you interested in serving as a class agent or regional representative?
Class Agent
Regional Representative
Both
How long can you commit to serving?
Are you currently active on social media or are you willing to be?
Yes
No
How did you hear about the Class Agent and Regional Representatives Program?
Alumni Website
Scanned a QR code at an event
Received an information sheet at AFW
Referred by a UD Alumnus/Alumna
Social Media
Other (please explain)
Please specify the Social Media Application (LinkedIn, Facebook, Instagram)
Name of the UD alumnus/alumna who referred you:
Please explain where you have heard of this program
Serving our Alumni Community
What interests you the most about becoming a Class Agent or Regional Representative?
Keep Me Connected
I understand and give my consent for this information to be used to contact me
Submit
