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:* must provide value
New
Renewal
Re-activate
Select one option.
Eligibility requirements for officers and members of a Student Organization (student interest groups, SIG): While it is not mandatory to have established By-Laws or a Constitution,
An appointed officer who is unable to fulfill his/her obligations and/or duties for any reason* must provide value
I Agree and Acknowledge.
I Disagree and do not Acknowledge.
Select one option
Officer #1 Name:* must provide value
Please provide the first and last name.
Officer #1 Title:* must provide value
Officer #1 Email:* must provide value
Officer #1 Local Address:
Officer #1 Phone Number:
Advisor Name: Please provide the first and last name.
Advisor Email:
Advisor Phone Number:
Is the Advisor a part of VCU faculty/staff? Yes No
Officer #2 Name:* must provide value
Please provide the first and last name.
Officer #2 Title:* must provide value
Officer #2 Email:
Officer #2 Local Address:
Officer #2 Phone Number:
Officer #3 Name: Please provide the first and last.
Officer #3 Title:
Officer #3 Email:
Officer #3 Local Address:
Officer #3 Phone Number:
Officer #4 Name: Please provide the first and last 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: Please provide the first and last name.
Member #1 Email:
Member #2 Name: Please provide the first and last name.
Member #2 Email:
Is your organization open to all VCU students (medical, nursing, PT, pharmacy, etc.)?* must provide value
Yes
No
If no, please specify
Are there any membership requirements specific to your organization (ex: application process,* must provide value
What are some small or large-scale event ideas that you have in mind? This includes events,* must provide value
If/when you become approved, you will have the option of requesting funding from the University.* must provide value
Will this organization have affiliation, now or in the future, with any local, regional, national,* must provide value
I affirm that the information contained on this request is true and correct to the best of my knowledge. * must provide value
I affirm that the information contained on this request is true and correct to the best of my knowledge.
I affirm that the information contained on this request is true and correct to the best of my knowledge.
I affirm that the information contained on this request is true and correct to the best of my knowledge.
I affirm that the information contained on this request is true and correct to the best of my knowledge.
I affirm that the information contained on this request is true and correct to the best of my knowledge.
I affirm that the information contained on this request is true and correct to the best of my knowledge.
I affirm that the information contained on this request is true and correct to the best of my knowledge. * must provide value
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