MICA New Student Organization Application

Student Organization Application
Please complete this form to request the establishment of a new student organization at MICA (or to re-establish a previously active organization). Upon completion, your application will be reviewed by the Center for Student Engagement within five (5) business days. If approved, you will be asked to schedule a 20-30 minute meeting with the CSE staff to discuss next steps.

If you have any questions regarding this request form or have not recieved a reply within five (5) business days, please email studentorgs@mica.edu.
Please select your reason for completing this form.*

Establish a new organization.Re-establish a previously active organization.

Organization Name*
Organization Type*
While your org may fall into multiple categories, please select the one that you feel BEST applies.
Purpose / Mission *
Please briefly describe the purpose and mission of your organization.
Target Audience*
Please briefly describe who the target audience of your organization would be.
Events, Programs, & Activities*
Please briefly describe what kind of events, programs, and/or activities you envision organizing as a student club.
Resources Needed*
Please briefly describe what kind of resources (funds, food, transportation, supplies, etc.) your organization might need from the Center for Student Engagement.
Would your club be associated with a national organization (i.e. student chapter)?*

YesNo
If yes, which organization?*
Contact Information
Contact Name*

First NameLast Name
Contact Email*
A confirmation email will be sent to this address.
Pronouns
Ex: She/Her, They/Them, He/Him

Member Information

Please list five MICA students who are interested in joining this club.
Member #1*

First NameLast Name
Member #1 Email*
example@example.com
Member #2*

First NameLast Name
Member #2 Email*
example@example.com
Member #3*

First NameLast Name
Member #3 Email*
example@example.com
Member #4*

First NameLast Name
Member #4 Email*
example@example.com
Member #5*

First NameLast Name
Member #5 Email*
example@example.com
Club Advisor

All student organizations are required to have a MICA faculty or staff advisor. Advisor responsibilities can be reviewed in the Student Organization Handbook. If you have already secured an advisor, please provide their information below. If you have not found an advisor, the Center for Student Engagement can assist.
Advisor Name

First NameLast Name
Advisor Email
example@example.com
Additional Comments
Anything else you would like CSE to know in reviewing your request?
By completing this form, I acknowledge that I have reviewed the Student Organization Handbook and understand the responsibilities of MICA student organization*

I acknowledge.
Should be Empty:

Student Organization Application