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

Applicant Email:

* must provide value

Applicant Phone Number:

* must provide value

Academic Year

* must provide value

Former Name of Organization

Name of Student Organization:

* must provide value

Student Organization Email Address:

* must provide value

Purpose of Organization:

* must provide value

Classify your Organization:

* must provide value

New

Renewal

Re-activate

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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) - It is required that your organization has a president and a 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 file

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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Officer #1 Name:

* must provide value

Officer #1 Title:

* must provide value

Officer #1 Email:

* must provide value

Officer #1 Local Address:

Officer #1 Phone Number:

Advisor Name:

Advisor Email:

Advisor Phone Number:

Is the Advisor a part of VCU faculty/staff?

Yes No

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Officer #2 Name:

* must provide value

Officer #2 Title:

* must provide value

Officer #2 Email:

Officer #2 Local Address:

Officer #2 Phone Number:

Officer #3 Name:

Officer #3 Title:

Officer #3 Email:

Officer #3 Local Address:

Officer #3 Phone Number:

Officer #4 Name:

Officer #4 Title:

Officer #4 Email:

Officer #4 Local Address:

Officer #4 Phone Number:

How many interested members do you currently have?

* must provide value

Member #1 Name:

Member #1 Email:

Member #2 Name:

Member #2 Email:

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

* must provide value

Yes

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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.
Officer #1 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.

Officer #2 Signature:

Add signature

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

Officer #3 Signature:

Add signature

I affirm that the information contained on this request is true and correct to the best of my knowledge.
Officer #4 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

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