ICC Club Representative Form
Use this form to notify and update the ICC Advisor when there's been a change in your ICC Rep student role. This will help us keep accurate contact information for our ICC Reps to receive communication from the Office of Student Life.
Name
*
First Name
Last Name
Club Name
*
Student Email:
*
example@example.com
How will they participate in the ICC?
*
Attending in-person/Zoom
Submitting electronic club reports
Submit
Should be Empty: