You must be an active Student Support Services participant to apply for the Student Advisory Board.

First Name

Last Name

Local Mailing Address

City

State

Zip

Local or cell phone

E-mail

Cumulative GPA

Fall 2009 Semester GPA

Current activities and organizations you are involved in (please specify dates)

Scholarships, awards, recognitions receieved (please specify approximate dates)

Please state why you are interestsed in serving on the SSS Student Advisory Board: