Student Government Association
Membership Form
Academic Year ________________
STUDENT CONTACT PROFILE
Name: ______________________________________________________________________
Address: ____________________________________________________________________
City: __
_____________________________ State: _________ Zip: ___________________
E-Mail Address: ______________________ Phone Number: _________________________
Program of Study: ___________________ Program Advisor: ________________________
Status: ___Full Time or ____Part Time Expected Graduation: _____________________
STUDENT LIFE PROFILE
Are you a member of any other club at Southern Crescent Technical College? ___YES or ___NO
If Yes, what clubs? ___________________________________________________________
Are you interested in being an SGA Officer?* ___YES or ___NO
*Candidates must be current, full-time students for at least one semester at SCTC and plan to be enrolled
throughout the next academic year. Students must also have a cumulative grade point average of 2.5
Are you interested in being part of the Student Ambassadors Program? ___YES or ___NO
Are you interested in helping to conduct tours of the College? ___YES or ___NO
Meetings are often held on Tuesday (Flint River Campus) and Thursday (Griffin Campus) from
12:00 PM to 1:00 PM. Will you be able to attend regularly?
(NOTE: If you have class, late arrival
and early departures are acceptable.) ___YES or ___NO
SIGNATURE: ____________________________________________ DATE: ____________
As set forth in full in its Student Handbook/Course Catalog, Southern Crescent Technical College does not discriminate on the basis of race, color,
creed, national or ethnic origin, sex, religion, disability, age, political affiliation or belief, genetic information, veteran status, or citizenship status
(except in those special circumstances permitted or mandated by law). The following persons have been designated to handle inquiries regarding
the non-discrimination policies: Title IX/Equity Coordinator (Griffin Campus, Butts County Center, Henry County Center, and Jasper County Center)
Toni Doaty, Assistant Director of Student Services, toni.doaty@sctech.edu, 501 Varsity Road, Mobile Unit 6B, Griffin, GA 30223, 770-228-7382;
ADA/Section 504 Coordinator (Griffin Campus, Butts County Center, Henry County Center, and Jasper County Center) Teresa Brooks, Special
Services Coordinator, teresa.brooks@sctech.edu, 501 Varsity Road, Mobile Unit 6B, Griffin, GA 30223, 770-228-7258; Title IX/Equity and
ADA/Section 504 Coordinator (Flint River Campus) Mary Jackson, Special Services Coordinator, mary.jackson@sctech.edu, 1533 Highway 19 South,
Room A-252, Thomaston, GA 30286, 706-646-6224.
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