Alumni Board of Directors Form Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Program(s) attended* Doctor of Osteopathic Medicine Doctor of Podiatric Medicine Doctor of Physical Therapy Master of Health Care Administration Master of Public Health Master of Science in Anatomy Master of Science in Biomedical Sciences Master of Science in Physician Assistant Studies Post-Professional Doctor of Physical Therapy Class yearProfessional certifications/otherWhat leadership role(s) did you play while attending Des Moines University?How have you been engaged and served as a leader and volunteer at DMU and/or your respective profession and/or community?Why is this role important to you?What are your goals if you were to be selected to serve in this capacity?Supporting documentsPlease attach or mail the following: Copy of your CV or resume Mailed documents may be sent to: Alumni Relations Office 3440 Grand Avenue Des Moines, IA 50312 Copy of your CV or resumeMax. file size: 800 MB. Δ
