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First name *

Last name *

Email *

Name of Student Organization/Interest Group *

How would you classify your organization?

Please Select Clinics Creative/Hobbies/Special Interest Honor Society Identity/Cultural/Faith Based Interest Group National Organization Outreach/Service/Education Other

If "Other" please explain

Leadership Positions

Leadership Position #1

Please Select President Vice President Treasurer Secretary Coordinator Representative Other

Name

Email Address

Leadership Position #2

Please Select President Vice President Treasurer Secretary Coordinator Representative Other

Name

Email Address

Leadership Position #3

Please Select President Vice President Treasurer Secretary Coordinator Representative

Name

Email Address

Leadership Position #4

Please Select President Vice President Treasurer Secretary Coordinator Representative

Name

Email Address

Leadership Position #5

Please Select President Vice President Treasurer Secretary Coordinator Representative

Name

Email Address

Faculty Advisor Form *

Organization Constitution *