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2012-2013 Student Organization Registration

1. Student Organization Annual Registration Information

This information must reflect changes effective September, 2012 through June, 2013

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* 1. ORGANIZATION

Question Title

* 2. MEMBERSHIP ELIGIBILITY

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* 3. STUDENT REPRESENTATIVE

Name:

College/School:

Anticipated Graduation Year:

Phone:

E-Mail:

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* 4. STUDENT REPRESENTATIVE - ALTERNATE

Name:

College/School:

Anticipated Graduation Year:

Phone:

E-Mail:

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* 5. FACULTY/STAFF ADVISOR

Name:

Department:

Campus Address:

Campus Phone:

Email: