IIEMembershipAppBanner

Chapter officer slate form

This form is used by professional and student chapters to annually confirm officer contact information or to report changes in officers. The following is a list of offices included in this form:

  • Faculty advisor (student only)
  • Recipient of chapter dues check (professional only)
  • President
  • Vice president
  • Secretary
  • Treasurer
  • HQ communications officer
  • Recipient of FTP access for member database (roster)
  • Recipient of roster (alternate)
  • Membership director
  • Newsletter editor
  • Two additional forms for other offices are also included at the end of this page


Please complete all fields and submit to IIE headquarters.


Fields marked in bold are required.


This section reports your general chapter information

Chapter name:

Chapter number:

Type of chapter:

Chapter Region:

When do the terms of office that you are reporting with this form begin?

When do the terms of office that you are reporting with this form end?

Chapter contact information:

 

Chapter Web site (if you have one):


For student chapters only:
This section is for reporting your Faculty Advisor.

 

Faculty advisor's name:

Preferred place of contact:

Faculty advisor's address:

 

Faculty advisor's phone number:

Faculty advisor's e-mail address:

Faculty advisor's IIE membership number:

Check this box if this is new information, or if it has changed since the last reporting.


For professional chapters only:
This section is for reporting your recipient of chapter dues checks

Recipient's name:

Preferred place of contact:

Recipient's address:

 

Recipient's phone number:

Recipient's e-mail address:

Recipients' IIE membership number:

Check this box if this is new information, or if it has changed since the last reporting.

 


For all chapters:
This section is for reporting your offices and officers

 

President:

President's name:

Preferred place of contact:

President's address:

 

President's phone number:

President's e-mail address:

President's IIE membership number:

Check this box if this is new information, or if it has changed since the last reporting.

 

Vice President:

Vice president's name:

Preferred place of contact:

Vice president's address:

 

Vice president's phone number:

Vice president's e-mail address:

Vice president's IIE membership number:

Check this box if this is new information, or if it has changed since the last reporting.

 

Secretary:

Secretary's name:

Preferred place of contact:

Secretary's address:

 

Secretary's phone number:

Secretary's email address:

Secretary's IIE membership number:

Check this box if this is new information, or if it has changed since the last reporting.

 

Treasurer:

Treasurer's name:

Preferred place of contact:

Treasurer's address:

 

Treasurer's phone number:

Treasurer's e-mail address:

Treasurer's IIE membership number:

Check this box if this is new information, or if it has changed since the last reporting.

 

HQ Communications Officer:

Communications officer's name:

Preferred place of contact:

Communications officer's address:

 

Communications officer's phone number:

Communications officer's e-mail address:

Communications officer's IIE membership number:

Check this box if this is new information, or if it has changed since the last reporting.

 

Recipient of FTP Access for Member Database (roster):

FTP access' name:

Preferred place of contact:

FTP access' address:

 

FTP access' phone number:

FTP access' e-mail address:

FTP access's IIE membership number:

Check this box if this is new information, or if it has changed since the last reporting.

 

Alternate Recipient of FTP Access for Member Database (roster):

Recipient of roster's name:

Preferred place of contact:

Recipient of roster's address:

Recipient of roster's phone number:

Recipient of roster's e-mail address:

IIE membership number:

Check this box if this is new information, or if it has changed since the last reporting.

 

Membership Director

Membership director's name:

Preferred place of contact:

Membership director's address:

 

Membership director's phone number:

Membership director's e-mail address:

Membership director's IIE membership number:

Check this box if this is new information, or if it has changed since the last reporting.

 

Newsletter Editor:

Newsletter editor's name:

Preferred place of contact:

Newsletter editor's address:

 

Newsletter editor's phone number:

Newsletter editor's e-mail address:

Newsletter editor's IIE membership number:

Check this box if this is new information, or if it has changed since the last reporting.

 

Additional Office - 1:

Title for this officer:

First additional officer's name:

Preferred place of contact:

First additional officer's address:

 

First additional officer's phone number:

First additional officer's e-mail address:

First additional officer's IIE membership number:

Check this box if this is new information, or if it has changed since the last reporting.

 

Additional Office - 2:

Title for this officer:

Second additional officer's name:

Preferred place of contact:

Second additional officer's address:

 

Second additional officer's phone number:

Second additional officer's e-mail address:

Second additional officer's IIE membership number:

Check this box if this is new information, or if it has changed since the last reporting.