New SHPE Jr. Chapter Application Form

Chapter Information
Sponsoring Chapter *
Chapter Name *
Must include SHPE in the name
School Name *
Region: *

Chapter Address *

Street Address
Street Address 2
City	State / Province
Postal / Zip Code	Country

Chapter Phone Number
Optional
Chapter Email Address:
Chapter Website:
Major Activities/Events
Estimated Annual Operating Budget
Total Members *
Social Media (optional):
Facebook
Instagram
LinkedIn
Snapchat
Twitter
SHPE Chapter Leadership
President *

First Name Middle Name Last Name
*
E-Mail
Member ID Number *
This number is found on your SHPE Connect account
Vice President *

First Name Middle Name Last Name
*
E-Mail
Member ID Number *
This number is found on your SHPE Connect account
Treasurer *

First Name Middle Name Last Name
*
E-Mail
Member ID Number *
This number is found on your SHPE Connect account
Secretary *

First Name Middle Name Last Name
*
E-Mail
Member ID Number *
This number is found on your SHPE Connect account
Month Elections are held:
Student Chapter Information
Chapter Advisor *

First Name Middle Name Last Name
Title

Advisor Mailing Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Advisor E-mail Address *
Advisor Phone Number *
Chapter Representative

First Name Middle Name Last Name

Representative Mailing Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Representative Phone Number
Representative E-mail Address
Academic System
Please provide, at minimum, six junior members in your chapter. Do not include your chapter leadership.

Founding Member 1
Name *

First Name Last Name
Member ID Number *
This number is found on your SHPE Connect account

Founding Member 2
Name *

First Name Last Name
Member ID Number *
This number is found on your SHPE Connect account

Founding Member 3
Name *

First Name Last Name
Member ID Number *
This number is found on your SHPE Connect account

Founding Member 4
Name *

First Name Last Name
Member ID Number *
This number is found on your SHPE Connect account

Founding Member 5
Name *

First Name Last Name
Member ID Number *
This number is found on your SHPE Connect account

Founding Member 6
Name *

First Name Last Name
Member ID Number *
This number is found on your SHPE Connect account
Do you have more founding members to include? *

Yes No

Founding Member 7
Name

First Name Last Name
Member ID Number
This number is found on your SHPE Connect account

Founding Member 8
Name

First Name Last Name
Member ID Number
This number is found on your SHPE Connect account

Founding Member 9
Name

First Name Last Name
Member ID Number
This number is found on your SHPE Connect account

Founding Member 10
Name

First Name Last Name
Member ID Number
This number is found on your SHPE Connect account

Founding Member 11
Name

First Name Last Name
Member ID Number
This number is found on your SHPE Connect account

Founding Member 12
Name

First Name Last Name
Member ID Number
This number is found on your SHPE Connect account

Authorization Page
Date

- Month - Day Year Date Picker Icon
Bylaws *
Must be a PDF file
You may review and fill the SHPE Jr. bylaw template here should you require guidance in creating this document. If you already have bylaws for your chapter, this template is NOT necessary.
Budget
School Agreement *
Enter the message as it's shown *

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