| Organization Name*: |
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| Club Contact Person*: |
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| Email*: |
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| Phone Number: |
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| Adviser Name*: |
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| Email*: |
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| Phone Number: |
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| What is your Club Purpose*: |
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| Does the Club have a constitution?*: |
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| If yes, please upload the Club Constitution here: |
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| Do you plan to charges dues?: |
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| If yes, how much per members and for what purpose?*: |
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| Provide Club membership List. (at least 5 names with Student ID numbers)*: |
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Acknowledgement
The undersigned representatives acknowledge that the approval of this charter application by the ASMHCC is contingent upon:
- Completion of this form
- The receipt of a member roster of 5 people or more students with their Student ID numbers.
- Approval of the organization's proposed constitution.
If the charter is approved, the members agreed to adhere to MHCC policies and procedures, Student Code of Conduct, all rules governing MHCC established by the State of Oregon and MHCC Board of Education.
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| Club Contact Person Signature |
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| Today's Date |
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| Club Advisor Signature |
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| Today's Date |
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