REQUEST TO ORGANIZE

(Charter Approval for Proposed Student Organization)

Name of Proposed Student Organization:

Location - On Campus:

Location - Off Campus:

Meeting Date:         Time:      Place:

President:  

Name:

Address:

Phone: (cell)          (email)

Vice President: 

Name:

Address:

Phone: (cell)           (email)

Secretary:

Name:

Address:

Phone: (cell)           (email)

Treasurer:

Name:

Address:

Phone: (cell)           (email)

Faculty/Staff Advisor:

Name:

Office:

Phone: (cell)          (email)

(Continued)

Form 1470/001 (front) (7/12)

Projects/Activities Planned for the Current Year:

This Organization Currently Consists of       Members * .

- - - - - - - - - - - - - - - - - (To Be Completed by the Student Life Office) - - - - - - - - - - - - - - - -

Checklist of Completed Procedures for Charter Approval:

Check:

Proposed Name of the Student Organization          ________

Purpose and/or Goals of Proposed Group            ________

List of Prospective Members (names, student I.D. #s)        ________

Proposed Meeting Date, Times and Location          ________

Signature Approval of Charter:

Director of Student Life            Date

______________________________________      ________________________

Vice Chancellor for Student Affairs        Date

Date Effective:__________________

* List of Prospective Members (names, student #s) must be attached to this form.

Form 1470/001 (back) (7/12)

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