Student Leadership & Membership Interest Form

Student Leadership & Membership Interest Form
Name*

First NameLast Name
Email*

Confirmation Emailexample@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Method of Contact:
Associated Student Body - Student GovernmentPhi Theta Kappa - National Honor SocietyThe National Society of Leadership and SuccessAnthropology ClubAmerican Sign Language ClubAssociated Latino American StudentsCCC Garden ClubChess ClubClay ClubGames ClubIndigenous Student AssociationOutdoor ClubStudent Advancing STEMOther
If other, specify Club/Organization:
Days and times available for meetings:*
President - Responsible for setting and monitoring goals; leading meetings; delegating duties, communication with CCC Students, Staff, Faculty, & District Governing BoardVice President - Provides assistance to the President and other club officers, assist other club members with their dutiesSecretary - Produces and maintains meeting notes, records, attendance, and services of club activities/eventsAmbassador - Promotes the club/organization's activities/events through a variety of communication mediaSenator - Serves as a club member and as a CCC committee voting member; making student voices be heard and standing up for students' rightsI just want to participate in club/organizational activities and meetingsOther
If other, specify membership title/position:
Academic AdvisingAssessment CommitteeCredentialing CommitteeCurriculum CommitteeDiversity and Inclusion CommitteeWellness CommitteeFacilities and Sustainability CommitteeFaculty SenateGeneral Education CommitteeStandards CommitteeOnline Instruction CommitteeSafety and Security CommitteeStrategic Enrollment Management CommitteeTeaching and Learning Development CommitteeI am NOT interested at this time
My goal/vision/ideas for the club/organization is:
What important conversations should CCC be engaged in:
Provide any comments or questions you might have:*
Should be Empty: