* Your Name:

* Email:

* Phone Number:

* Your position/relationship with the organization:

* Name of Organization

Organization Phone #

Organization Email

President (name, e-mail, and phone #)

Advisor (name, e-mail and phone #)

1. Is your organization associated with an academic department?

Yes
No

2. Is your organization eligible for office space in another building?

Yes
No

3. Number of active members:

4. Check the type of services your organization provides:

5. What specific campus service does your organization provide?

6. List the most successful program/activity/accomplishment of your organization in the past year?

7. List your organization's top objective for the 2011-2012 academic year.

8. Briefly justify your need for storage space.