Student Organization Registration

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Please fill out this form to register your Student Organization. Use the "Save and Return Later" feature if you cannot complete the form in one session.

Please note: The answers to these questions will NOT affect your organization's ability to register as a student organization.

Applicant Name:

* must provide value

Please provide your first and last name.

Applicant Email:

* must provide value

Applicant Phone Number:

* must provide value

Academic Year

* must provide value

(example: 2016-2017)

Former Name of Organization

Name of Student Organization:

* must provide value

Note: A student organization may not use VCU or MCV directly in the name of the organization because this might imply sponsorship. Example: MCV Student Free Clinic is NOT allowed. Student Free Clinic at VCU is CORRECT

Student Organization Email Address:

* must provide value

Purpose of Organization:

* must provide value

Classify your Organization:

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New

Renewal

Re-activate

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Select one option.

Eligibility requirements for officers and members of a Student Organization (student interest groups, SIG):

1) List 4 members - must be a full time VCU student and actively enrolled in the School of Medicine. You must list two officers (minimum) - the president and treasurer, as well two additional members.

2) The registration form must have all signatures to be processed.

3) While it is not mandatory to have a Faculty/Staff Advisor, it is highly recommended.

While it is not mandatory to have established By-Laws or a Constitution,
it is highly recommended. If your group has either of these documents, please
provide a copy with your registration form.

Upload document

An appointed officer who is unable to fulfill his/her obligations and/or duties for any reason
during the academic school year should contact the office of Student Affairs and other
officer(s)/member(s) of the organization. Any financial data and/or banking
documents should be turned over to his/her fellow member or a staff member of the
Student Affairs Office.

Please Agree to and Acknowledge this requirement.

* must provide value

I Agree and Acknowledge.

I Disagree and do not Acknowledge.

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Select one option

President Name:

* must provide value

Please provide the first and last name of the student organization's president.

President Email:

* must provide value

President Local Address:

President Phone Number:

Advisor Name:

Please provide the first and last name of the Advisor for the organization.

Advisor Email:

Advisor Phone Number:

Is the Advisor a part of VCU faculty/staff?

Yes No

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Vice President Name:

Please provide the first and last name of the Vice President for the organization.

Vice President Email:

Vice President Local Address:

Vice President Phone Number:

Treasurer Name:

Please provide the first and last name of the treasurer for the organization.

Treasurer Email:

Treasurer Local Address:

Treasurer Phone Number:

Secretary Name:

Please provide the first and last name of the Secretary for the organization.

Secretary Email:

How many interested members do you currently have?

* must provide value

Member #1 Name:

Please provide the first and last name of one of the member's of your organization

Member #1 Email:

Member #2 Name:

Please provide the first and last name of a second member of your organization.

Member #2 Email:

Is your organization open to all VCU students (medical, nursing, PT, pharmacy, etc.)?

* must provide value

Yes

reset

If no, please specify

Are there any membership requirements specific to your organization (ex: application process,
membership dues, etc.)?

* must provide value

What are some small or large-scale event ideas that you have in mind? This includes events,
service projects, fundraisers, etc.

* must provide value

If/when you become approved, you will have the option of requesting funding from the University.
What are some things your organization will want/need if funded?

* must provide value

Will this organization have affiliation, now or in the future, with any local, regional, national,
or international organization? If Yes, please name and describe affiliation. If no, please write No.

* must provide value

I affirm that the information contained on this request is true and correct to the best of my knowledge.

President Signature:

* must provide value

Add signature

I affirm that the information contained on this request is true and correct to the best of my knowledge.

Advisor Signature:

Add signature

I affirm that the information contained on this request is true and correct to the best of my knowledge.

Vice President Signature:

Add signature

I affirm that the information contained on this request is true and correct to the best of my knowledge.

Treasurer Signature:

Add signature

I affirm that the information contained on this request is true and correct to the best of my knowledge.

Secretary Signature:

Add signature

I affirm that the information contained on this request is true and correct to the best of my knowledge.

Member #1 Signature:

Add signature

I affirm that the information contained on this request is true and correct to the best of my knowledge.

Member #2 Signature:

Add signature

I affirm that the information contained on this request is true and correct to the best of my knowledge.

Applicant Signature:

* must provide value

Add signature

You have selected an option that triggers this survey to end right now. To save your responses and end the survey, click the button below to do so. If you have selected the wrong option by accident and do not wish to leave the survey, you may click the other button below to continue, which will also remove the value of the option you just selected to allow you to enter it again and continue the survey.

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This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range.

The value you provided is outside the suggested range.

This value is admissible, but you may wish to verify.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

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