Student Leadership & Membership Interest Form

Student Leadership & Membership Interest Form
Name *

First Name Last Name
Email *

Confirmation Email example@example.com
Phone Number *
Please enter a valid phone number.
Preferred Method of Contact:
I am interested in the following Club(s)/Organization(s):

Associated Student Body - Student Government Phi Theta Kappa - National Honor Society The National Society of Leadership and Success Anthropology Club American Sign Language Club Associated Latino American Students CCC Garden Club Chess Club Clay Club Games Club Indigenous Student Association Outdoor Club Student Advancing STEM Other
If other, specify Club/Organization:
Days and times available for meetings: *
I want to serve as: *

President - Responsible for setting and monitoring goals; leading meetings; delegating duties, communication with CCC Students, Staff, Faculty, & District Governing Board Vice President - Provides assistance to the President and other club officers, assist other club members with their duties Secretary - Produces and maintains meeting notes, records, attendance, and services of club activities/events Ambassador - Promotes the club/organization's activities/events through a variety of communication media Senator - Serves as a club member and as a CCC committee voting member; making student voices be heard and standing up for students' rights I just want to participate in club/organizational activities and meetings Other
If other, specify membership title/position:
I would like to be a member of 1 or more of the following CCC Committees:

Academic Advising Assessment Committee Credentialing Committee Curriculum Committee Diversity and Inclusion Committee Wellness Committee Facilities and Sustainability Committee Faculty Senate General Education Committee Standards Committee Online Instruction Committee Safety and Security Committee Strategic Enrollment Management Committee Teaching and Learning Development Committee I 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: