Application for Organization Recognition or Renewal
Organization Name:_______________________________________________________
Purpose:________________________________________________________________
National Affiliation, if any:__________________________________________________
Organization meeting dates/times:____________________________________________
Check appropriate line:
Check appropriate line:
Complete below:
Organization Status
___New, first time organization
___Reregistering organization
___Changing officer &/or
advisor
Organization’s Constitution is:
___New and attached
___Revised and attached
___No changes made
Membership Information
Active members
________
Affiliate members ________
Officer and Member Information
We, the undersigned, hereby request application or renewal of official registration for this
organization in order that we may continue to use the name and facilities of Kent State
University East Liverpool Campus. We agree to abide by the rules and regulations of the
University, specifically those which regulate student organizations. Every voting member
of this organization is a registered student or member of the faculty or staff of Kent State
University.
Full Name:__________________________
Address:____________________________
City, State, Zip:_______________________
Signature:___________________________
Organization Position:_PRESIDENT_____
Email address:_______________________
Phone Number:______________________
Last 4 digits of SSN:___________________
Full Name:__________________________
Address:____________________________
City, State, Zip:_______________________
Signature:___________________________
Organization Position:_Vice President_____
Email address:_______________________
Phone Number:______________________
Last 4 digits of SSN:___________________
(Continued on Back)
Full Name:__________________________
Address:____________________________
City, State, Zip:_______________________
Signature:___________________________
Organization Position:_Treasurer_________
Email address:_______________________
Phone Number:______________________
Last 4 digits of SSN:___________________
Full Name:__________________________
Address:____________________________
City, State, Zip:_______________________
Signature:___________________________
Organization Position:__Secretary___
Email address:_______________________
Phone Number:______________________
Last 4 digits of SSN:___________________
Full Name:__________________________
Address:____________________________
City, State, Zip:_______________________
Signature:___________________________
Organization Position:Student Gov’t Liaison
Email address:_______________________
Phone Number:______________________
Last 4 digits of SSN:___________________
Full Name:__________________________
Address:____________________________
City, State, Zip:_______________________
Signature:___________________________
Organization Position:__Faculty Advisor_
Email address:_______________________
Phone Number:______________________
Last 4 digits of SSN:___________________