This information is required and must be submitted to the Office of Student Life and Development in order to be a recognized as a registered student organization.

Student Organization Name:
Academic Year:
Advisor: Advisor: First Last
Advisor's Email:
Each student organization needs at least four members to be registered. Please provide a list of student’s names, BearPass Numbers (example: M01234567), and their office title below. Student organizations that do not have the traditional executive officer structure, may type in the names of at least four student members below.
President: President: First Last
President's BearPass #
Vice-President: Vice-President: First Last
VP's BearPass #
Secretary: Secretary: First Last
Secretary's BearPass #
Treasurer: Treasurer: First Last
Treasurer's BearPass #
Add an Additional Member?

Add an Additional Member? Yes No
Member 1: Member 1: First Last
Title 1 (optional)
Member 1 BearPass #
Additional Member 2?

Additional Member 2? Yes No
Member 2: Member 2: First Last
Title 2 (optional)
Member 2 BearPass #
Additional Member 3?

Additional Member 3? Yes No
Member 3: Member 3: First Last
Title 3 (optional)
Member 3 BearPass #
Additional Member 4?

Additional Member 4? Yes No
Member 4: Member 4: First Last
Title 4 (optional)
Member 4 BearPass #
Signature Date: Signature Date: / MM / DD YYYY
Draw your signature below or select "Type" to type in your name.

Draw or Type

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Full Name

I understand this is a legal representation of my signature.
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