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Title


Registration Type


Semester


Date Received

Club Name


To update club information choose club name from the drop down list

Meeting


Club's Meeting Day/Time & Location

Club Website

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Type the description: 

Club Email


Elections

Date when elections were held. Please remember to attach minutes.

Officers Elected?

In order to charter a student club and maintain recognition at Kingsborough Community College, your group must elect from its membership the following officer positions: President, Vice-President, Treasurer, and Secretary. An officer must have a 2.0 minimum GPA and the President may not serve as an officer of student government. Club must also obtain a faculty or full-time staff member to serve as club advisor. Minutes showing the election results must be turned in with this form.

President

First Name


President's First Name

Last Name


President's last name

SS#


President-last 4 digits of ss#

Street Address


President's address-street

City


President's address-City

State


Zip


President's address-zip

Ph#


Preferred Phone Number

Email


Email

Info Authorization

I authorize the Office of Student Life to share my contact information and my email with other club presidents and KCC students interested in joining my club.
Vice-President

First Name


Last Name


SS#


Street Address


Vice President's address-street

City


Vice president's address-city

State


Zip


Vice president-zip

Ph#


Vice president-preferred phone #
xxx-xxx-xxxx

Email


Vice president's email
Treasurer

First Name


treasurer's first name

Last Name


treasurer's last name

SS#


Last 4 digits of SS

Street Address


treasurer's address-street

City


treasurer's address-city

State


Zip


treasurer's address-zip

Ph#


treasurer's preferred phone #

Email


treasurer's email address
Secretary

First Name


secretary's first name

Last Name


secretary's last name

SS#


Last 4 digits of SS

Street Address


secretary's address-street

City


secretary's address-city

State


Zip


secretary's address-zip

Ph#


secretary's preferred phone #

Email


secretary's email
Advisor

First Name


Faculty/Staff Advisor-

Last Name


Faculty/Staff Advisor-last name

Department


Mail Code


Room#


Faculty/Staff Advisor-Room #

KCC Ph. Ext.


Faculty/Staff Advisor-Campus phone

Email


Faculty/Staff Advisor-KCC email address

Previous Service

Have you served as advisor to this club in the past?

How Long


If so, for how many years?

Guidelines

I have received the faculty advisor guidelines, and I have agreed to be the club/organizations's advisor
Attachments
 
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Kingsborough Community College
2001 Oriental Boulevard, Brooklyn, NY 11235-2398 | (718)-368-5000
Kingsborough is CUNY