Request for Student Representative

111 University Parkway, Suite 202

Yakima WA 98901

Phone: 509-452-5100

Fax: 509-452-5101
Request for Student Representative(s) on a Committee
Name of Committee
Date of Request

MonthDayYear
Requestor's Name

First NameLast Name
Requestor's Email
Number of Students Requested
Preferred Class Year: (select as many as you like)

Class of 2015Class of 2016Class of 2017Class of 2018Class of 2019No Preference
Duration of Committee?
How often does the Committee meet?
Time of day Committee meets?
Date by which you need a student assigned

MonthDayYear
Do you prefer a SGA member or student from the general student body?

SGAGeneral Student BodyNo preference
Suggestions of students you would like considered for the committee (Optional):
Comments
** Note** A request may take a minimum of two weeks to process.
For Official Office Use Only
Request Approved

YesNo
Name of Student Assigned to Committee:
Name of Student Assigned to Committee:
Name of Student Assigned to Committee:
Name of Student Assigned to Committee:
Should be Empty:

Request for Student Representative(s) on a Committee