INTER CLUB COUNCIL
Butte College Student Club Re-Activation Form
CLUB INFORMATION
CLUB NAME:
NAME: (LASTNAME, FIRSTNAME M.I.)
TYPE OF REGISTRATION:
FALL YEAR:
SPRING YEAR:
CLUB MEETING DATES, TIMES AND LOCATION (MUST MEET A MINIMUM OF 4 TIMES A SEMESTER):
TYPE OF CLUB:
ACADEMIC
CULTURAL/ETHNIC
POLITICAL
PROFESSIONAL
SERVICE
SOCIAL
OTHER
CLUB DESCRIPTION FOR CLUB WEBSITE (typed attachment ok):
DOES YOUR CLUB CURRENTLY HAVE ANY OF THE FOLLOWING?
GROUP E-MAIL
HOW MANY MEMBERS DOES YOUR CLUB HAVE?
FACEBOOK PAGE
MyBC
If applicable please list:
STUDENT OFFICERS
OFFICER NAME:
OFFICER ID NUMBER:
OFFICER CLASS YEAR:
1ST YR
OFFICER TELEPHONE:
2nd YR
3rd YR
4th YR+
3rd YR
4th YR+
3rd YR
4th YR+
OFFICER E-MAIL:
OFFICER POSITION:
PRESIDENT
VICE PRES
OFFICER NAME:
TREASURER
SECRETARY
OFFICER ID NUMBER:
OTHER:
OFFICER CLASS YEAR:
1ST YR
OFFICER TELEPHONE:
2nd YR
OFFICER E-MAIL:
OFFICER POSITION:
PRESIDENT
VICE PRES
OFFICER NAME:
TREASURER
SECRETARY
OFFICER ID NUMBER::
OTHER:
OFFICER CLASS YEAR:
1ST YR
OFFICER TELEPHONE:
2nd YR
OFFICER E-MAIL:
OFFICER POSITION:
PRESIDENT
Revision 6/8/15
VICE PRES
TREASURER
SECRETARY
OTHER:
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INTER CLUB COUNCIL
OFFICER NAME:
OFFICER ID NUMBER::
OFFICER CLASS YEAR:
1ST YR
OFFICER TELEPHONE:
2nd YR
3rd YR
4th YR+
3rd YR
4th YR+
OFFICER E-MAIL:
OFFICER POSITION:
PRESIDENT
VICE PRES
OFFICER NAME:
TREASURER
SECRETARY
OFFICER ID NUMBER::
OTHER:
OFFICER CLASS YEAR:
1ST YR
OFFICER TELEPHONE:
2nd YR
OFFICER E-MAIL:
OFFICER POSITION:
PRESIDENT
VICE PRES
TREASURER
SECRETARY
OTHER:
Please list additional officers on a separate sheet of paper.
ICC REPRESENTATIVE
REPRESENTATIVE’S NAME:
OFFICER ID NUMBER:
CLASS YEAR:
1ST YR
TELEPHONE:
E-MAIL:
ALTERNATIVE REPRESENTATIVES’S NAME:
OFFICER ID NUMBER:
TELEPHONE:
E-MAIL:
2nd YR
3rd YR
4th YR+
2nd YR
3rd YR
4th YR+
CLASS YEAR:
1ST YR
FACULTY ADVISOR
FACULTY ADVISOR NAME:
FACULTY ADVISOR SIGNATURE:
FACULTY ADVISOR TELEPHONE:
FACULTY ADVISOR E-MAIL:
FACULTY Co-ADVISOR NAME:
FACULTY Co-ADVISOR SIGNATURE:
FACULTY Co-ADVISOR TELEPHONE:
FACULTY Co-ADVISOR E-MAIL:
PREFERRED ADVISOR EMAIL FOR CLUB WEBSITE:
PREFERRED ADVISOR PHONE NUMBER FOR CLUB WEBSITE:
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INTER CLUB COUNCIL
MEMBERSHIP LIST
*You may attach your own list*
NAME
Revision 6/8/15
EMAIL
ID NUMBER
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INTER CLUB COUNCIL
ATTACHMENTS
To complete the club recognition process, please attach the following documents to this application form:
 CALENDAR OF PLANNED EVENTS (Noting meeting times/locations and major events)
 Check with the Student Life Office for your updated CLUB CONSTITUTION, including:





Name and mission statement of the club
All requirements for membership, including any dues or fees
Qualifications for holding office, if applicable
Methods of selecting and replacing officers, if applicable
Explanation of any formal affiliations the organization has with outside agencies
Please submit completed application packets to Student Life Office in Campus Center 145. Notification of recognition decision will be
sent via e-mail to the organization’s President, ICC Representative, and Faculty Advisor.
AGREEMENT
Signatures of club leadership below indicate understanding and agreement of the following:
1.
EXPECTATIONS. I understand and accept the regulations and responsibilities regarding student
organizations specified within the handbook. Specifically, I understand that alcoholic beverages
may not be served or consumed at any formal or informal gathering of the student organization I
represent.
2.
ELIGIBILITY. In order to retain voting privileges and funding eligibility from the Inter-Club Council, I
understand that our organization must be represented at ICC General Council meetings each
semester held on the 1st and 3rd Tuesday of the month from 11 AM-12:30 PM in the ICC Lounge.
3.
INTEGRITY. As a leader of an accredited student organization, I recognize that I will be trusted with
decisions and resource allocations on behalf of the entire student body. I will expend allocated
funds only in a manner consistent with the policies and procedures, will preserve transparency and
accountability in all transactions, and will not tolerate disreputable acts of others. Furthermore, I
will conduct all organization business in a professional and courteous manner.
ICC DELEGATE NAME:
ICC DELEGATE SIGNATURE:
DATE:
ICC ALTERNATE DELEGATE NAME
ICC ALTERNATE DELEGATE SIGNATURE
DATE
CLUB PRESIDENT NAME:
CLUB PRESIDENT SIGNATURE:
DATE:
FACULTY ADVISOR NAME:
FACULTY ADVISOR SIGNATURE:
DATE:
Please turn this form to the ICC Advisor at zunigayv@butte.edu. Drop off a hardcopy with the signatures to
the Student Life Office in the Campus Center 145 first floor by the fourth Friday of the semester.
Revision 6/8/15
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