UIA Observer Sign-Up Thank you for your interest in becoming a UIA Observer! Please complete the fields below. Question Title * 1. Name of Institution: Question Title * 2. Does your institution have a President or Chancellor? President Chancellor Question Title * 3. President / Chancellor Information: Name Direct Email Administrative Support person's name Administrative Support person's email Administrative Support person's phone number Question Title * 4. Person who will serve as the primary Student Success Innovation Liaison to the UIA: Name Title Email Phone number Administrative Support person's name Administrative Support person's email Administrative Support person's phone number Question Title * 5. Person completing this form: Name Title Email Phone number Question Title * 6. Optional: does your campus have a student success initiative aligned with the vision and values of the UIA that you would like to share? Question Title * 7. Optional: are there any issues or concerns your campus would like to address, or areas you'd like to learn more about? Question Title * 8. Any other questions or comments? Done
