Fillable Student Club Application Form (DigiPen Institute of Technology)

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Student Club Application Form (DigiPen Institute of Technology)

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File type: PDF

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Form# 73-13-016
9931 Willows Road NE, Redmond, WA 98052 | Phone: (425) 558-0299 | Fax: (425) 558-0378 | www.digipen.edu
Student Club Application Form
Fill out this form to submit your request to form a new club. Return this form to the
Oce of Student Aairs. Room Use Agreement forms may be found online at:
https://www.digipen.edu/current-students/
List 5 currently-enrolled (6 credit minimum) DigiPen students:
Student clubs are required to have a faculty or sta advisor. Faculty and sta advisors are encouraged, but not required, to attend club
meetings, engage with student club members regularly, and guide members through club processes. Faculty and sta may only advise
up to THREE student clubs.
Club Name: Date:
Club Description and Mission Statement:
Charter Membership Roster:
Faculty/Sta Club Advisor
Designated Representative:
Name (First, Last)
Name (First, Last)
Name (First, Last)
Name (First, Last)
Faculty/Sta Club Advisor Name:
Email:
Email:
Email:
Email:
Email:
Contact Info:
Phone:
Phone:
Phone:
Phone:
Phone:
Signature:
Student ID:
Student ID:
Student ID:
Student ID:
Student ID:
How often does your club plan on meeting?
Consecutive Club Meetings
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I, the Designated Representative, have read and understand the policies and guidelines outlined in the Student Club Handbook. I agree
that our club will abide by these policies and guidelines. Should the club or club members violate any of the stated rules and procedures,
our club may lose its charter.
Designated Representative Signature: Date:
DigiPen Club Agreement
Students must fill out the Room Booking Agreement Form and submit it to the Academic Administration Window on the second floor.
DigiPen Room Booking
In order to receive a club charter, the Designated Representatives MUST meet with the Student Life Advisor. By signing below, the
Student Life Advisor approved the club charter.
Student Life Advisor Approval and Charter
Student Club Application Form, Continued
Student Life Advisor Signature:
Additional Notes:
Form# 73-13-016
9931 Willows Road NE, Redmond, WA 98052 | Phone: (425) 558-0299 | Fax: (425) 558-0378 | www.digipen.edu
Date:
IT Member Signature:
IT: Can the student club’s IT request be met?
If the request cannot be met, why?
If your club plans on requesting software, patches, or games being downloaded in the computer labs, you must receive approval from
the IT Department prior to receiving your club charter.
Computer Lab Setup Request
Yes:
No:
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Student Club Application Form (DigiPen Institute of Technology)

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Completed 28 January 2021

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