SPE Student Chapter Information Form

Student Chapter Information Form

This form is completed by the Student Chapter Faculty Advisor.

Academic Year: *
School: *
School Address 1: *
School Address 2:
City: *
State: *
Zip/Postal Code: *
Country: *
Phone: *
Faculty Advisor: *
Faculty Advisor Title: *
Faculty Advisor Phone: *
Faculty Advisor Email: *
Student Chapter President Name: *
Student Chapter President Email: *
Student Chapter Vice President Name: *
Student Chapter Vice President Email: *
Student Chapter Secretary Name: *
Student Chapter Secretary EMail: *
Student Chapter Treasurer Name: *
Student Chapter Treasurer EMail: *
Student Liaison to Sponsoring Section Name: *
Student Liaison EMail: *
Please upload any additional information that may be pertinent to aid the Student Chapter Petition.



Your form submission WILL be encrypted using SSL to ensure your privacy.


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