Student Organization Re-Registration Form
LaGrange College
Organization Name: ________________________________________________
Date: ___/___/_____
Please give a short description of your organization:
When are your organizations meetings held? ______________________________________
How often does your organization meet? __________________________________________
What is the anticipated date of new officer elections? _______________________________
Mailing Address
Name: __________________________________________________________
Address: ________________________________________________________
City, State, Zip: __________________________________________________
Organization Contact Email: _______________________________________
Faculty/Staff Advisor
Name: _________________________________________________________
Department: ____________________________________________________
E-mail: _________________________________________________________
Phone: _________________________________________________________
Organization Officers
President: ____________________________________
Email/Phone: _________________________________
Vice-President: ________________________________
Email/Phone: _________________________________
Treasurer: ____________________________________
Email/Phone: _________________________________
Secretary: ____________________________________
Email/Phone: _________________________________
Does your organization collect dues? Yes: _____ No: _____
To the best of my knowledge and my fellow officer's knowledge, all of the following statements
are correct: Our most current constitution, by-laws, and those of any regional or national
organization(s) are on file in the Student Engagement Office. Our members are part-time or
full-time LaGrange College Students. To the best of my knowledge, the organization's
purposes and its activities are not in conflict with LaGrange College purposes, regulations and
policies, or with State and/or Federal laws and regulations. With this signature, I hereby give
permission for the above information to be made public upon request and give permission for
Student Involvement to verify my enrollment.
Signature (Organization President): ___________________________________________
LC# _____________________ Date _____/_____/_______
Signature (Faculty/Staff Advisor): ____________________________________________
Date ____/_____/_______
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LaGrange College Account
Through filling out this section you are opening an account through LaGrange College in which
soap funds are able to be deposited. This account is not limited to soap funds usage. It can be
used for organizational personal operational purposes.
Organization Name: _________________________________
President: __________________________________________ LCID: ______________
Signature: __________________________________________
Email/Phone: _______________________________________
Advisor Name (Faculty/Staff): _______________________________
Advisor Signature (Faculty/Staff): ____________________________
Email/Phone: _____________________________________________
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