Flinn-Brown Fellows Directory Update  Survey

With almost 500 Fellows, there is always a lot happening. We know about some of your achievements and activities but want to capture as many as possible.

NOTE: If you would like to update your headshot, please upload it to this Google Drive folder.

1.We are making every effort to ensure your records are complete and up to date. For this section, please use your HOME address.(Required.)

Name

Home Address

Home Address 2

City/Town

State/Province

ZIP/Postal Code

Preferred Email Address

Cell Phone Number

2.For this section, please provide your MAILING address if it is different from your home address - for example if you use a PO Box to receive mail, enter that here:

Mailing Address

Mailing Address 2

City/Town

State/Province

ZIP/Postal Code

Country

3.We would love to know your birthday!

MM / DD / YYYY

Date

SuSunday

MoMonday

TuTuesday

WeWednesday

ThThursday

FrFriday

SaSaturday

5.Please tell us if you have any past or current military affiliation, including branch and years of service.

6.What is your voter party registration?

This information is for demographic purposes only. We strive for the Fellowship to reflect Arizona, including political party affiliation statistics, and would like to gather the data necessary to help us measure this accurately.

7.Tell us about your current place of employment:(Required.)

Name of organization/place of buisiness:

Your current job title:

How long have you been in this role:

If retired, date of retirement:

10.What has been new in your professional or civic leadership activities this year? (Check all that apply.)

Ran for state elected office

Ran for local elected office

Appointed to a state board or commission

Appointed to a local board or commission

Appointed to a non-profit board

Not applicable - no changes to report

Tell us about the boxes you checked. Include the name of the office/board/commission as well as relevant dates.

11.Are you planning on any of the following in the next year?

Run for state level elected office

Run for local level elected office

Apply for a state board or commission

Apply for a local board or commission

Please tell us about the boxes you checked. For which office are you running/applying?

12.If you are CURRENTLY in elected office, please provide your title and jurisdiction:

State Level (e.g. legislature, statewide):

Local Level (e.g. county, city, town):

School or Community College District:

Other:

Year elected:

13.If you were PREVIOUSLY in elected office, please provide your title and jurisdiction:

State Level (e.g. legislature, statewide):

Local Level (e.g. county, city, town):

School or Community College District:

Other:

Years served:

14.Help us plan educational and professional development opportunities for Fellows.

Do you have an idea for a CivEx session you would like to plan/present with staff?

Yes! I'd love to share my idea for partnering on a future session.

No, not at this time

If yes, please tell us about your idea.

15.Do you have an idea for a theme for the Annual Flinn-Brown Convention?

Yes

No

Please share your ideas here and please indicate if you would be interested in participating in the planning committee.

16.We'd like to find you on social media. Please share your:

LinkedIn profile (full URL)

X (Twitter) handle

Instagram