Boise State University I

PLEASE PRINT CLEARLY OR TYPE Date: _____/_____/ 20_____

E-mail: ______

Phone: (______) ______- ______

Student ID#: ______

Address: ______Street City State Zip

Class standing: ___Grad ___Sr ___Jr ___Soph ___Fresh

Class Credits Spring 2015 Semester: ______Cumulative GPA: ______Expected Date of Graduation: ______

Declared Major(s): ______

Minor(s): ______

Why are you interested in serving on this committee?

How would you solicit student input on tuition and fees?

What experience do you have that is relevant and helpful to serving on this committee?

List current campus employment and involvement: ______

Please indicate BSU references (non-relative) who have first-hand knowledge of your campus involvement, academic achievement, and/ or work experience:

Name Address Phone

I certify that all the statements made in this application are true, complete, and correct to the best of my knowledge. I understand and agree now, and anytime during my committee appointment, that my enrollment status and GPA may be verified.

Signature of Applicant Date

APPLICATION DEADLINE: January 30, 2015

Return completed application to: Office of the Vice President for Student Affairs In Person: Administration Building 208 By E-mail: [email protected] Fax: (208) 426-1062

Questions? - Call (208) 426-1418