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Student Activities

Elliott Union 217
Warrensburg, MO 64093
Phone: 660.543.4007



Existing Organizations: Login to Manage Account

Student Organization Request Form

General Information

BEFORE submitting this form check here to see if your organization has already been submitted.

Please note: If you copy and paste any text from Microsoft Word please replace unique characters like the "double dash" (-) or apostrophe (') by retyping in your browser.

Name of Student Organization (No Abbreviations):  
Abbreviation Used by Student Organization:  
Named Used Last Semester If Different:  
Mailing Address:  
Organization Web Address:  

(A link will be made available to your organization from the Office of Campus Activities web page)
How many current active members in your local affiliation:  
To the best of your knowledge how many students in your organization are:   Male
Female
To the best of your knowledge how many students in your organization are:   American Indian
Asian
Black
Hispanic
Non-minority
Other


Category
Please choose ONE category that best describes the organization:   Academic/Departmental
Community Service
Cultural Heritage/Ethnic Identity
Honor Society
Recreational/Club Sport
Religious
Social Greek Organization
Special Interest/Misc (please specify)
Please select a maximum of two subcategories that fit your organization's profile:   Agricultural
Aviation
Business
Campus Programming
Communications/Media
Community/Volunteer Service
Computer Sciences
Dance
Education
Engineering
Fashion
Foreign Languages
Greek Lettered Organizations
Health & Wellness
History
Honor Society
Housing
Law
Management
Mathematics
Multicultural/Diversity
Music
Non-traditional Students
Political
Recreation/Club Sport
Religious
ROTC
Safety
Science
Sexual Orientation
Student Government
Theatre
Visual Arts
Writing

Required Information

By placing names on this form you will
  • abide by UCM's policies and procedures
  • authorize the Office of Campus Activities to provide names, phone numbers and/or e-mail addresses as official contacts for the organization listed above
  • only list student ucmo email addresses
Primary Student Contact/President/Chairperson (will receive correspondence from Office of Campus Activities)
Name:  
Title:  
Student ID:  
Mailing Address:  
City, State Zip:  
Phone:  
Email:  
Secondary Student Contact (in case primary student contact cannot be reached)
Name:  
Title:  
Student ID:  
Mailing Address:  
City, State Zip:  
Phone:  
Email:  
Primary Faculty / Staff Advisor (Please note: Advisors must be full time faculty or staff and cannot advise more than 3 organizations)
Name:  
Department:  
Campus Address:  
Campus Phone:  
Email:  
Secondary Advisor (Optional):
Name:  
Department:  
Campus Address:  
Campus Phone:  
Email:  

Organization Members

Please list six currently enrolled University of Central Missouri students who will be members of the organization.
(Please note: this information will be kept confidential)
Member or Officer 1
Name:  
Title:  
Student ID:  
Member or Officer 2
Name:  
Title:  
Student ID:  
Member or Officer 3
Name:  
Title:  
Student ID:  
Member or Officer 4
Name:  
Title:  
Student ID:  
Member or Officer 5
Name:  
Title:  
Student ID:  
Member or Officer 6
Name:  
Title:  
Student ID:  
Organization Description & Activities
Please give a brief description (50 words or less) of the organization. This information will be available for review by prospective members.
  
How often does your organization meet:  
Does your organization collect dues:   Yes   No
If so, how often does each member pay dues:   Local Dues   National Dues
How much does each member pay in dues:   Local Dues   National Dues

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