Student Senate Representative Agreement Form

Name

First Last

Date

Email

Checkmark each statement below to indicate that it is true and accurate.*

I plan to attend all meetings as scheduled once per month unless clinical interferes.
I will be active in Student Senate for two events per semester.
I will participate in one event pertaining to Bellin Banquet (example but not limited to decorations, set-up, or clean-up).
I am in good standing, meaning not on academic probation and/or non-academic probation at time of election (Being on clinical monitoring; however, is considered good standing and allows you to be a representative of Senate).
If your status changes, you are required to notify Student Senate facilitator(s).

Signature

Sign by printing your name in the box below.*