Executive Leadership Team Interest Form

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    Thanks for your interest in joining the Executive Leadership Team. Students must be a member of an official Madison College club in order to participate on the Executive Leadership Team. Please complete the form and indicate which roles interest you the most. Our advisor will be in contact with you shortly to provide you with more information about the Executive Leadership Team.

    Please enter your first and last name.

    Please enter your 7-digit student ID number listed on your OneCard.

    Please enter your home phone number in the following format: (608) 246-6576

    Please enter your cell phone number in the following format: (608) 246-6576

    Enter your street address (Example: 3550 Anderson St.)

    Enter your 5-digit zip code

    Enter the e-mail address you would like us to use to contact you

    Please list the campus where you attend most of your classes

    What program are you attending at Madison College?

    How many credits are you enrolled in this semester?

    Please indicate which roles you are interested in. You can select more than one.

    Briefly, explain why you are interested in the Executive Leadership Team?

    Do you have any additional information you would like to share?

    Last Modified: April 5, 2012