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Chief Executive

Given Name(s):

Family Name:

Title/Role/Position: (of Chief Executive Officer)

President

Rector

Chancellor

Vice Chancellor

Other -- Please specify:

 

Institution

Name of Institution:

Address:

City:

State or Province:

ZIP or Postal Code:

Country:

Contact Information

Institution Website:

Telephone Number:

Personal Email:

Assistant's Name:

Assistant's Email:

Please Contact Via:

Assistant's Email

Personal Email

Both Email Addresses

 

Please note: this online form is designed for the formal enrolment of academic institutions in the UN Academic Impact by their Chief Executive Officers only. All other expressions of support to the UN Academic Impact are welcome and should be channelled through the UN Academic Impact Facebook page at http://www.facebook.com/ImpactUN .

To Chief Executive Officers

* Submitting this form indicates your endorsement of the Principles of Academic Impact, and your willingness to have your institution and yourself identified as participants in the Academic Impact program.

Other Contacts

For all interactions other than agreement to participate, please use the Comments and Questions form.

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