PEP University Chapter Application Form (Ontario)

University Chapter Application Form

Apply to open a new chapter of our organization at your university.
University Name*
University Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Applicant Full Name*

First NameLast Name
Applicant Position/Title at University*
Applicant Email Address*
example@example.com
Applicant Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Why do you want to open a chapter at your university?*
YesNoSupport is pending approval
Describe your plans or proposed activities for the chapter.*
How many students are interested in joining the chapter?