Thank you for your interest in being on the Wilfrid Laurier University Alumni Association Board of Directors! This application form is for screening purposes only. It will be reviewed and we will let you know about any next steps if there is an opportunity available. If there are no opportunities available at this time, we will keep your form on file for when an opportunity arises.

First Name: 

"First Name" is required.

Last Name: 

"Last Name" is required.

Laurier ID (if known):

Graduation Year: 

"Graduation Year" is required.

Primary Email: 

Email

"E-mail" is required.

Confirm Email
"E-mail" confirmed text is required. Emails do not match! "E-mail"needs to contain a valid entry.

Your password must have

each of the above components

and be at least 12 characters.

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Passwords match! Emails match! Inputs match!

Phone Area Code:

Phone Number: 

"Phone Number" is required.

Address 

"Address" is required.

Preferred Address 2:

City: 

"City" is required.

Prov/State: 

Please Choose Alberta British Columbia Manitoba New Brunswick Newfoundland & Labrador Nova Scotia Nunavut NW Territories Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Foreign State Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New South Wales New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Province/State not applicable Province/State not declared
"Prov/State" is required.

Postal/Zip Code: 

"Postal/Zip Code" is required.

Country: 

Please Choose Canada USA Afghanistan Albania Algeria Angola Antigua & Barbuda Argentina Armenia Aruba Australia Austria Azerbaidjan Azores Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia Botswana Brazil British Virgin Islands British West Indies Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Republic Canal Zone (Panama) Cayman Islands Chile China Christmas Islands Colombia Congo (Brazzaville) Congo, Dem. Republic of Cook Island Costa Rica Croatia Cuba Cyprus Czech Rep Czech Republic Denmark Dominica Dominican Republic Ecuador Egypt El Salvador England Eritrea Estonia Ethiopia Fiji Islands Finland France French Polynesia Gambia Germany Germany (East) Ghana Gibraltar Greece Grenada Guam Guatemala Guinea Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland (Eire) Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Korea, North Korea, South Kuwait Kyrqyzstan Laos Latvia Lebanon Liberia Libya Lithuania Luxembourg Macao Madagascar Malawi Malaysia Mali Malta Martinique Mauritius Mexico Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar (Burma) Namibia Nepal Netherlands Netherlands Antilles Neutral Zone (incl. Curacao) New Caledonia New Zealand Nicaragua Niger Nigeria Northern Ireland Norway Oman Pakistan Palestine Panama Papua/New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saudi Arabia Scotland Senegal Serbia & Montenegro Sierre Leone Singapore Slovak Republic Slovenia Somalia South Africa Spain Sri Lanka St Kitts & Nevis St Lucia St Vincent & the Grenadines Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Trinidad Tobago Tunisia Turkey Turkmenistan Turks & Caicos Islands U.S.S.R. (Russia) UAE Uganda Ukraine United Kingdom Uruguay Uzbekistan Venezuela Vietnam Vietnam (South) Virgin Islands (Us) Wales Yemen Zaire Zambia Zimbabwe Nation not declared
"Country" is required.

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The University collects personal information under the authority of the Wilfrid Laurier University Act. Personal information collected by any part of the University may be used or disclosed by other units in order to execute the functions of the University and to administer the relationship between the University and its students, alumni, employees, clients, suppliers, partners and others.  

Further information about how your personal information is collected, used and disclosed can be found in Laurier’s Notice of Collection, Use, and Disclosure of Personal Information.