Fillable APPLICATION FOR REGISTRATION (Kapiolani Community College)

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APPLICATION FOR REGISTRATION (Kapiolani Community College)

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1
REGISTERED INDEPENDENT ORGANIZATIONS (RIO)
APPLICATION FOR REGISTRATION
This application should be filled out to register your organization at Kapi`olani Community College
(Kapi`olani). Although registration does not make the RIO a part of or controlled by the University, it allows
the organization certain benefits, which are reviewed in the RIO Orientation.
The first deadline for submittal is September 30. However, if your organization does not meet this deadline,
registration is accepted throughout the academic year.
We advise registering early so new students looking to get involved have access to your organization’s most
current information, during summer orientation and at the beginning of the semester. Please contact the
Office of Student Activities (OSA) at 734-9576 if you need assistance with this application.
Registration Checklist
o Completed Application
o Constitution/Charter of the Organization
o RIO Orientation
o Names and Signatures of the four (4) Designated RIO Representatives
o If applicable, affiliation with any local, national, or international organization if not
already on file with OSA, that Organization’s Constitution, Charter and/or By-Law
o Current Membership Roster
Please submit completed applications to the Office of Student Activities (OSA) in `Iliahi 126 for approval.
2
REGISTERED INDEPENDENT ORGANIZATIONS (RIO)
APPLICATION FOR REGISTRATION
The information on this page may appear on the Office of Student Activities (OSA) web site at UH-
Kapi`olani CC and be included in an information folder and RIO Listing in the OSA office to serve as a
resource for members of the campus community.
1. Name of Organization ___________________________________________________
Commonly used abbreviation (if any) ____________________________________________
2. Describe the purpose(s) of the organization clearly and specifically (please limit to 30 words or less):
3. RIO email address (if any): ______________________________________________________
4. RIO website address (if any): _____________________________________________________
5. Main Contact Person_______________________________ Telephone: __________________
UH email: _____________________@hawaii.edu
6. Advisor (Optional): _________________________________Telephone: __________________
Kapi`olani Affiliation: check one ( Faculty, Staff) UH email: ___________________@hawaii.edu
7. Membership Requirements/Dues: ___________________________________________
8. Meeting Day, Time, & Location: _____________________________________________
9. Programs and Projects Planned:
10. Federal Tax ID/EIN# (if any):_____________________________________________
State General Excise Tax License # (if any)__________________________________
11. Has the organization been registered on campus before? No Yes under what
name(s)
12. Describe any affiliation the organization has with other campus, local, state, national, or international
organizations or agencies:
13. A copy of this organization’s most current constitution is (check one):
attached on file was amended and attached
3
Identify below the names and positions of four (4) individuals currently enrolled as students or employed as
faculty, APT, or clerical staff at Kapi`olani Community College, who will serve as the designated
representatives of the organization. (Advisors are not mandatory, however, they are highly recommended).
These individuals will be authorized to assume responsibility of the organization. Indicate each person’s
affiliation with Kapi`olani (e.g. faculty, staff, student; faculty & staff-please include department). The main
contact(s) will receive correspondence from the OSA office via e-mail. It is the responsibility of the main
contact(s) to pass on the information to the organization. Also, the main contact person(s) must attend a
mandatory RIO Orientation session.
Name Position Kapi`olani UH EMAIL UH ID #
(Pres., V.P Affiliation (@hawaii.edu)
Sec., Member) (Faculty & Staff-Include Dept)
(1)_________________________________________________________@hawaii.edu____________________
(2)_________________________________________________________@hawaii.edu____________________
(3)_________________________________________________________@hawaii.edu____________________
(4)_________________________________________________________@hawaii.edu____________________
*To obtain your UH Number go to the following URL: www.hawaii.edu/account. After you log into the
sign-in box located on this page, you will be able to retrieve your 8-digit UH Number.
IMPORTANT: Officers and/or designated representatives listed below read and understand the Administrative Policies
and Terms of Agreement.
NAME OF ORGANIZATION: ____________________________________________
(1)__________________________________ ____________________________
Print Name Signature
(2)__________________________________ ____________________________
Print Name Signature
(3)__________________________________ ____________________________
Print Name Signature
(4)__________________________________ ____________________________
Print Name Signature
Attended RIO Orientation: ( __yes/___ no) If yes, give date of RIO Orientation________
All new forming RIOs must attend an RIO Orientation with the Office of Student Activities before their
application for registration can be approved. Please contact OSA located in `Iliahi 126 or at (808) 734-9576 for
more information about scheduling an individual or group RIO orientation. The RIO Orientation must be
attended by two (2) of the designated four (4) individuals.
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4
(To be signed at the completion of the RIO Orientation)
IN WITNESS THEREOF, the parties have executed this Agreement below:
NAME OF RIO: ______________________________________________________________
BY________________________________________________________________________
RIO Authorized Representative(s) NAME [Main Contact Person(s)]
BY________________________________________________________________________
RIO Authorized Representative(s) SIGNATURE [Main Contact Person(s)]
TITLE: _____________________________________________________________________
DATE: ______________________________________________________________________
Office of Student Activities Representative Approval (For office use)
BY_____________________________________________________________________
University Authorized Officer’s Name (OSA Representative) (Print)
BY_____________________________________________________________________
University Authorized Officer’s Signature
DATE:_________________________________________________________________
Effective Date of Agreement
ATTACH THE ORGANIZATION’S CONSTITUTION OR STATEMENT OF PURPOSE(S); AND RETURN ALL
COPIES OF THIS FORM TO THE OFFICE OF STUDENT ACTIVITIES AT KAPI`OLANI LOCATED IN `Iliahi
126.
For Office Use Only:
Category: __Academic/Professional __Ethnic/Cultural
__Sports/Leisure __Religious/Spiritual
__Service __Political
__Other (specify):____________________________
5
MEMBERSHIP ROSTER
List below the names and Kapi`olani email addresses of other members of the RIO NOT including the four
members previously listed.
Name UH Email
1)____________________________________________ ________________@hawaii.edu
2)____________________________________________ ________________@hawaii.edu
3)____________________________________________ ________________@hawaii.edu
4)____________________________________________ ________________@hawaii.edu
5)____________________________________________ ________________@hawaii.edu
6)____________________________________________ ________________@hawaii.edu
7)____________________________________________ ________________@hawaii.edu
8)____________________________________________ ________________@hawaii.edu
9)____________________________________________ ________________@hawaii.edu
10)___________________________________________ ________________@hawaii.edu
11)___________________________________________ ________________@hawaii.edu
12)___________________________________________ ________________@hawaii.edu
13)___________________________________________ ________________@hawaii.edu
14)___________________________________________ ________________@hawaii.edu
15)___________________________________________ ________________@hawaii.edu
16)___________________________________________ ________________@hawaii.edu
17)___________________________________________ ________________@hawaii.edu
18)___________________________________________ ________________@hawaii.edu
ATTACH ADDITIONAL SHEETS IF NECESSARY
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APPLICATION FOR REGISTRATION (Kapiolani Community College)

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Completed 7 September 2020

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