Name of Organization

Organization name is required

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Brief Mission Statement of Organization

Mission Statement is required

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Our Club is Best Categorized as: (choose one)

Academic/Professional

Service & Advocacy

Fraternity/Sorority

Honor Society

Interest Activity/Group

Religous Group

Cultural Group

Sports Club (first must be registered with Campus Recreation (801-626-7108))

Please select a category

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Organization Cost Code

If your club/organization has not requested a cost code yet, or if you are unsure as to whether or not the club/organization already has a cost code, please contact Heather Cimino, (801)626-6824.

Cost Code:
Organizational Website:
National Affiliate (if affiliated):

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Student Leader (Club President)

First Name:	President first name is required
Last Name:	President last name is required
Email address:	President email is required address@domain.com
Phone Number:	President phone number is required XXX-XXX-XXXX
	Please check box if we may provide your phone number and email address to interested students.

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Club Advisor

The individual must be a full-time WSU faculty member and/or staff member.

First Name:	Advisor first name is required
Last Name:	Advisor last name is required
Email address:	Advisor email is required address@domain.com
Phone Number:	Advisor phone number is required XXX-XXX-XXXX
Department:	Advisor's department is required
WSU Extension:	Advisor WSU extension is required
Mail Code:

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Risk Management

On a scale of 1-5 (1 being the least risky and 5 being the most risky), please indicate the level of risk you believe characterizes your club/organization (this can be based on the physicality of club activities, amount of involvement in the community, etc.)

1: Not Risky at All

2:

3: Moderately Risky at Times

4:

5: Exteremely Risky

Risk management scale is required

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Club/Organization Club Constitution

If there are changes to the club constitution, please submit an updated version to Heather Cimino via email at heathercimino@weber.edu or you may submit a copy to the Office of Student Involvement and Leadership, UB326

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Club/Organization Roster

To be officially recognized and registered at WSU, each club needs a minimum of 8 members. Please submit an updated roster for your club/organization, including first and last name of each member- please separate each name by a comma. If you wish, you may also turn in a hard copy of your club roster to the Office of Student Involvement and Leadership, UB326.

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