Date Submitted: _____/_____/_____
Mo
Day
Yr
STUDENT ORGANIZATION OFFICER LISTING FORM
TO BE COMPLETED EVERY SEMESTER
Please complete this form and submit to the Office of Student Involvement, SU3504.
By completing and submitting this form, you agree that your organization’s contact information will be updated in the
University’s records. The PRIMARY CONTACT and ADVISOR will receive all official communications about deadlines
and other important announcements via their UT email address (NOT Gmail, hotmail, etc). Please type or print clearly.
Student Organization
Organization Email (If applicable)
Organization Webpage (If applicable)
UT Advisor’s Name
UT Department
Advisor’s Email Address
Phone Number
Non-UT Advisor’s Name
Community Position
Advisor’s Email Address
Phone Number
Primary Contact Name
Position/Title
Email Address
Street Address
Phone Number
City
2nd Contact Name
City
City
Zip
State
Zip
State
Zip
State
Zip
Position/Title
Email Address
Phone Number
City
5th Contact Name
Position/Title
Email Address
Phone Number
City
6th Contact Name
Position/Title
Email Address
Street Address
State
Phone Number
4th Contact Name
Street Address
Zip
Position/Title
Email Address
Street Address
State
Phone Number
3rd Contact Name
Street Address
Zip
Position/Title
Email Address
Street Address
State
Phone Number
City
QUESTIONS / CONCERNS - Please contact the office below for questions.
Office of Student Involvement
Student Union 3504
419-530-4944
studentorganizations@utoledo.edu
Anti-Hazing, Anti-Harassment, Non-Discrimination Compliance Form
All student organizations must file this form with the Office of Student Involvement (SU 3504) on an annual basis to certify
compliance with the University Anti-Hazing and Non-Discrimination policy. This document will remain on file until a new
one id filed with current leadership listed.
Organization Name:
UT Hazing Policy
The University of Toledo supports the autonomy of its student organizations within the established rules and regulations outlined in the
student handbook and other official University publications. Initiation into a University organization is permissible excluding any
activities that may be construed as hazing. Hazing is defined as an act which endangers the mental or physical health or safety of a
student or which destroys or removes public or private property for the purpose of initiation, admission into, affiliation with or as a
condition of continued membership in an organization. The expressed or implied consent of the victim will not be a defense. Apathy or
acquiescence in the presence of hazing is not a neutral act: they are violation of this rule. When a student organization is found to be
involved in hazing activity, the University shall have the authority to initiate disciplinary action regardless of the location of the activity.
Such action shall be conducted in compliance with normal student organization conduct proceedings. Student organizations found in
violation of the University hazing policy shall be subject to the range of sanctions available to the University as outlined in the student
code of conduct.
UT Policy on Sexual Assault and Harassment
The University of Toledo affirms its commitment to maintain an environment that is free from humiliation, coercion, or intimidation. The
University of Toledo will not tolerate sexual assault of any kind. Sexual assault can include any form of actual or attempted sexual
activity perpetrated upon a person without the consent of that person and against that person’s will. Discriminatory harassment of any
kind will not be tolerated; verbal, physical or otherwise, based on sex, gender identity, race, color, national origin, religion, disability,
age, veteran status or sexual orientation, that has the purpose or effect of interfering with a person’s work or educational performance;
creates an intimidating, hostile or offensive working, learning or living environment; or interferes with a person’s ability to participate in
or benefit from a class, an educational program or activity; or will cause physical or mental injury.
UT Non-Discrimination Policy
In alignment with the University of Toledo’s non-discrimination policy, no student organization may discriminate on the basis of race,
color, religion, sex, age, national origin, sexual orientation, veterans status or presence of a disability (unless specifically exempted by
law) in the admission to, assess to, treatment, or employment in, their programs or activities.
Signatures
The leaders of our organization have read and understand the University of Toledo’s policy statements on Discrimination, Harassment,
and Hazing. Further, we have informed the members and pledges/associate members of our organization of the concepts of the
Universities policies. All activities sponsored and/or required by our organization are in compliance with these policies. On behalf of this
organization, and with its authority, the undersigned promises and agrees that the organization will abide by all federal, state, and local
laws, and all rules and regulations of the University of Toledo. It is also understood that submission of this application and its approval
does not constitute in and of itself full recognition as a University of Toledo student organization.
Student Leader Signature
Title
Date
Student Leader Signature
Title
Date
Student Leader Signature
Title
Date
Student Leader Signature
Title
Date
Student Leader Signature
Title
Date
Student Leader Signature
Title
Date
Advisor Signature
Title
Date