Name:                       
          Exactly as it should appear in Committee Manual

Title:

Department:         Department Zip:

Work Phone:                                     Home Phone:

Email:                                    Fax:

Faculty/Administrative Information:

        Faculty                Graduate Faculty                        Current Senator

Years Employed at WSU:                                   Percentage of Appointment:

Committees Interested in Serving on:

Relevant Experience and Qualifications:*

Committee Experience - Current WSU

Committee Experience - Previous WSU or Elsewhere

*For many committees little or no previous experience is necessary.