APPLICATION FORM FOR ASSOCIATE STATUS

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					       APPLICATION FORM FOR ASSOCIATE STATUS
COLUMBUS STATE UNIVERSITY SERVANT LEADERSHIP PROGRAM

NAME: ____________________________________ Student ID No._____________________

ADDRESS: ___________________________________________________________________
                                                               City     State     Zip Code
PHONE: ________________ E-MAIL: _____________________________________________

CURRENT MAJOR: ______________________ GPA: ____________

Status (please check one): _____freshman ____sophomore ____junior ____senior

Are you currently enrolled in or have you completed LEAD 1705? _______________________

Have you previously applied to the CSU Servant Leadership Program? ____________________

Are you a transfer student who was a member of a servant leadership program at another
university? ____________ If yes, which university? __________________________________


CAMPUS OR COMMUNITY ORGANIZATIONS OR ACTIVITIES:
(Please attach additional sheets if necessary.)
Activity:             Your contribution to or position within the organization:              Date:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________


HONORS, AWARDS, OR SPECIAL RECOGNITION AND DATES RECEIVED:
(Please attach additional sheets if necessary.)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Please return completed form to:             Kelli Parker
                                             Columbus State University
                                             Schuster Room 118
                                             4225 University Avenue
                                             Columbus, Georgia 31907-5645



Phone: (706) 507-8772                   e-mail: kparker@pilink.org
For additional information, visit our website at servant.colstate.edu