| Personal Information: |
| * First Name: |
|
Middle Name: |
|
| * Last Name: |
|
* Email: |
|
| * Address: |
|
| * City: |
State:
ZipCode: |
| * Home Phone: |
|
Cell Phone: |
|
| Spouse First Name: |
|
Last Name: |
|
| Children: |
|
Ages: |
|
| Employment: |
| Company Name : |
|
| Position: |
|
Years Employed: |
|
| Education: |
| |
Highest Academic Degree:
|
| |
|
| History of Community Service:
|
 |
(1) Chinese Club of San Marino/Chinese School of San Marino involvement: |
| From: |
|
To: |
| Describe your involvement: |
|
 |
|
(2) Organization:
|
| From: |
|
To: |
| Describe your involvement: |
|
|
|
(3) Organization:
|
| From: |
|
To: |
| Describe your involvement: |
|
|
|
(4) Others: |
| Describe your involvement: |
|
| If elected on the Board, indicate the position(s) you find interesting: |
| |
|
| Personal Note: Please describe why you want to be on the Board of CCSM |
| |
|
| |
Submitted by :
|
Date: |
|