Student Government Association
Miami Dade College, North Campus
North Campus
SGA MEMBERSHIP APPLICATION
APPLICANT INFORMATION
Please print clearly
Name:
Date of birth: (
mm/dd/yyyy)
____/______/______
Student #
-
-
Current address:
City: State: ZIP Code:
Country: Gender: Male Female (Please Circle or check one)
Home Phone: Cell Phone: Work Phone:
Fax: Other: URL:
Email:
EDUCATION
Please print clearly
Current Campus:
Major: GPA:
Number of credits currently Registered: Estimated Graduation Date:
Are you involved in other organizations? Yes No (Please cirle or check one) If yes, Please list below your current organization(s)
1: 2: 3:
EMPLOYMENT
Please print clearly
Are you currently employed?
Name of Employer:
Date of employment: (
mm/dd/yyyy)
____/____/_____
Type of Employment:
(e.g. full time)
Phone:
EMERGENCY CONTACT
Please print clearly
Name:
Address:
City: State: ZIP Code:
Phone: Email:
(Optional)
Relationship:
MEMBERSHIP
Select only one membership type
(Check one Box) ( for more information about membership, see attached brochure)
Senator: Ambassador: Intern:
Are you able to complete the required office hours: Yes No
(Please circle or check one)
SIGNATURES
I affirm that the above information is true to the best of my knowledge. I authorize the Student Government Association of Miami Dade College, North
Campus to verify any information required to process my membership. I have read the enclosed information packets and affirm to know the
responsibility of being a member of the Student Government Association of Miami Dade College, North Campus.
Signature of applicant:
Date:
(
mm/dd/yyyy)
____/_____/________
