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Petition to Organize a New or Re-activate a Club

By Jeffrey Green,2015-01-15 21:06
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Petition to Organize a New or Re-activate a Club

     Montgomery College Office of Student Life (OSL) Rockville Campus

Official Club Recognition for: ; Fall ; Spring

Date submitted

All fields required

Club Name:

Please select ONE category among the following that you wish to classify your club as

    ? academic ? department affiliated ? recreational

    ? community service ? political ? religious

    ? cultural ? social ? Other

In the space provided below, please explain why you want to become a club, describe the nature

    of your club, and benefits that may be derived from membership. A complete and accurate

    description is crucial.

    Please list your club goals and the activities to achieve them.

Fall Semester Goals:

    1.

    2.

    3.

Activities to Achieve Goals:

    1

    2

    3

(Revised 011613 VAM) Page 1 of 4

Spring Semester Goals:

    1.

    2.

    3.

Activities to Achieve Goals:

    1

    2

    3

Regularly scheduled meetings:

Day: Time: am/pm Location:

    Club officers/leadership: (Minimum GPA of 2.0 and current enrollment for (3) three credit hours required)

President

    MCID

    Phone #

    Email

    As the President of my club, I understand that it is my responsibility to see that all of the officers

    as listed in the application are familiar with the college policies and procedures and my club may be held liable for damaged facilities and/or damaged equipment reserved in the name of this club.

Signature

    ****************************************************************************** Vice President

    MCID

    Phone #

    Email

    As the Vice President I understand that it is my responsibility to fulfill my duties/ role as stated in

    the club constitution and become familiar with the club program policies and procedures.

Signature

    (Revised 011613 VAM) Page 2 of 4

Secretary

    MCID

    Phone #

    Email

    As the Secretary I understand that it is my responsibility to fulfill my duties/ role as stated in the club constitution and become familiar with the club program policies and procedures.

Signature

    ******************************************************************************

Treasurer

    MCID

    Phone #

    Email

    As the Treasurer I understand that it is my responsibility to fulfill my duties/ role as stated in the club constitution and become familiar with the club program policies and procedures.

Signature

    ******************************************************************************

Additional officer/member

MCID

    Phone #

    Email

    As the I understand that it is my responsibility to fulfill my duties/ role as stated in the club constitution and become familiar with the club program policies and procedures.

Signature

    ******************************************************************************

Advisor: (Montgomery College faculty or staff member required)

    Advisor

    Phone #

    Email

    Department

    Office/room

    As the advisor I understand that it is my responsibility to fulfill my duties/ role as stated in the Advisor Agreement Form.

Signature

    ****************************************************************************** (Revised 011613 VAM) Page 3 of 4

Public Contact Information

Name

    Title

    Email

Consent to release information:

    I have read the above information and give consent to Montgomery College to release my name and email to any member of the pubic who may want to learn more about my student club. I also understand that the Office of Student Life will print my contact information in the Official Club listing.

Signature

******************************************************************************

    By signing this document all involved pledge to comply with Office of Student Life and Montgomery College policies and procedures.

    Please attach your signed copy of the Club Constitution and Advisor Agreement Form.

    Official Club Status is valid only when the club has received a Letter of Recognition from the Office of Student Life.

    Please return all forms to the Office of Student Life Front Desk, Campus Center Building, room 005.

Do not write below this line.

    ******************************************************************************

    This document has been approved by:

Student Senate

     (Print) (Signature)

    Date

Director of Student Life

     (Print) (Signature)

    Date

This document is valid from to

(Revised 011613 VAM) Page 4 of 4

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