Class Agent Interest Form

Thanks for your interest in serving as a class agent!

First Name Required Field

Last Name

Maiden Name:

Alumni Class Year:

Address 1: Required Field

Address 2:

Address 3:

City:

State:

Zip:

Cell Phone Number: Required Field

Primary E-mail Address Required Field

If you are applying as a group, please list who you wish to serve with. Class Agent Pair/Group:

Please have each person fill out the form individually.

Current Employer and Job Title

Major(s) at Augustana

What activities/organizations were you involved in while attending Augustana?

What activities/organizations are you currently involved in?

What interests you about becoming a class agent?

What do you feel will be your best contribution as a class agent?