Campus Compact Member Information

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					                    Hawaii Pacific Islands Campus Compact
                             Member Information
       Please complete and forward this to your state Compact office. New members will be sent a
       Welcome Packet from the National Campus Compact office based on the information provided
       on both sides of this sheet. Please call your state Compact office or (808) 956-4641 with
       questions. Thanks!

       College/University Name _______________________________________
       Address ________________________________________________________________
       City, State, Zip ___________________________________________________________
       Main Phone # ____________________________________________________________
       Date Joined __________________________ Today’s Date ________________________

                    Number of Full-Time Equivalent Undergraduate Students:
President                                         President’s Staff Contact

Salutation (Mr., Ms., Dr.) ____________________    Salutation (Mr., Ms., Dr.) _____________________
Name ____________________________________          Name _____________________________________
Title _____________________________________        Title ______________________________________
Campus Address ___________________________         Campus Address ____________________________
_________________________________________          __________________________________________
Telephone: ________________________________        Telephone: _________________________________
Fax: _____________________________________         Fax: ______________________________________
E-Mail ___________________________________         E-Mail: ____________________________________



Press Contact                                     Government Relations Contact

Salutation (Mr., Ms., Dr.) ____________________    Salutation (Mr., Ms., Dr.) ______________________
Name ____________________________________          Name ______________________________________
Title _____________________________________        Title _______________________________________
Campus Address ___________________________         Campus Address _____________________________
_________________________________________          ___________________________________________
Telephone: ________________________________        Telephone: __________________________________
Fax: _____________________________________         Fax: _______________________________________
E-Mail ___________________________________         E-Mail: ____________________________________



           HIPICC * 2600 Campus Road * University of Hawaii at Manoa * Honolulu, HI 02912
        Phone: (808) 956-4641 * Fax: (808) 956-3394 * http://www.hawaii.edu/servicelearning/hipicc/
Chief Academic Officer Contract                   Chief Student Affairs Officer Contact

Salutation (Mr., Ms., Dr.) ____________________   Salutation (Mr., Ms., Dr.) ______________________
Name ____________________________________         Name ______________________________________
Title _____________________________________       Title _______________________________________
Campus Address ___________________________        Campus Address _____________________________
_________________________________________         ___________________________________________
Telephone: ________________________________       Telephone: __________________________________
Fax: _____________________________________        Fax: _______________________________________
E-Mail ___________________________________        E-Mail: ____________________________________




Community Service or Service-Learning             Faculty Service-Learning Contact
Program Contact

Salutation (Mr., Ms., Dr.) ____________________   Salutation (Mr., Ms., Dr.) ______________________
Name ____________________________________         Name ______________________________________
Title _____________________________________       Title _______________________________________
Campus Address ___________________________        Campus Address _____________________________
_________________________________________         ___________________________________________
Telephone: ________________________________       Telephone: __________________________________
Fax: _____________________________________        Fax: _______________________________________
E-Mail ___________________________________        E-Mail: ____________________________________




          HIPICC * 2600 Campus Road * University of Hawaii at Manoa * Honolulu, HI 02912
       Phone: (808) 956-4641 * Fax: (808) 956-3394 * http://www.hawaii.edu/servicelearning/hipicc/