HACE Young Professionals Board Application Applicant Information Full Name: Date of Birth: Main Phone: Current address: City: State: Email: Ethnicity: ZIP Code: Employment Information Current employer: Years of professional work experience: Job Title: Phone: E-mail: City: State: ZIP Code: Leadership Skills & Information Promotion or Special Recognition received: Committees You Lead: Activities: Career Goals Short Term (1 year): Long Term (3-5 years): Management 330 S. Wells | Suite 1104 | Chicago IL 60606 | haceonline.org HACE Young Professionals Board Application Education Undergraduate Institution: Graduate Institution: Certification: Other: Associations & Organizations Name of Organization: Role: Tenure: Statement of Purpose Please include a statement, maximum of 500 words, explaining what you hope to achieve and how you plan to contribute to the HACE Young Professionals Board. Please attach document. I certify that the information above is true. Signature of applicant Date 330 S. Wells | Suite 1104 | Chicago IL 60606 | haceonline.org
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