Student Leadership & Membership Interest Form

Student Leadership & Membership Interest Form

Please complete this form to indicate your interest in participation within campus clubs and organizations.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Preferred way of contact:
I am interested in the following Club(s)/Organization(s):

American Sign Language ClubAnthropology ClubAssociated Latino American StudentsAssociated Student Body - Student GovernmentChess ClubClay ClubCCC Games ClubCCC Garden ClubIndigenous Student AssociationThe National Association of Home BuildersPhi Theta Kappa - National Honor SocietyStudent Advancing STEMOther
If other, specify Club/Organization:
I want to serve as:*

President - Responsible for setting and monitoring goals; leading meetings; delegating duties; communication with CCC Students, Staff, Faculty, and District Governing BoardVice President - Provides assistance to the President and other club officers, assist other club members with their dutiesSecretary - Produces and maintains meeting notes, records, attendance, and services of club activities/eventsAmbassador - Promotes the club/organization's activities/events through a variety of communication mediaSenator - Serves as a club member and as a CCC committee voting member; making student voices be heard and standing up for students' rightsI just want to participate in club/organizational activities and meetings
If other, specify membership title/position
I would like to be a member of 1 or more of the following CCC Committees:

Academic AdvisingAssessment CommitteeCredentialing CommitteeCurriculum CommitteeDiversity and Inclusion CommitteeWellness CommitteeFacilities and Sustainability CommitteeFaculty SenateGeneral Education CommitteeStandards CommitteeOnline Instruction CommitteeSafety and Security CommitteeStrategic Enrollment Management CommitteeTeaching and Learning Development CommitteeI am NOT interested at this time
My goal/vision/ideas for the club/organization is:
What important conversations should CCC be engaged in:
Provide any comments or questions you might have:
Is there anything we can do to ensure your full participation and accessibility at the Student Leadership Experience?
I have read and agree to the following - Student Expectations:

This is a CCC funded activity, thus students are still held under the Student Code of Conduct of Coconino Community College.COVID-19 Precautions: If you feel sick and/or are showing any symptoms of illness (coughing, fever, etc.) STAY HOME. You are encouraged to bring and wear protective face masks.Cabins: Cabins sleep 6-8 campers. There are designated cabins for all gender identities.Behavioral issue or any misconduct will not be tolerated. Illegal issues will be dealt with by legal authorities.Student(s) need to let Staff know of any medical, prescriptions, disabilities, allergies, dietary needs, etc., in order for proper support.There will be absolutely no alternative travel arrangements or other activities accomodated.Student will respectfully and collaboratively work out any issues with CCC Staff or Camp Staff.CCC expects students to fully participate in the leadership retreat activities.Support each other and always take safety precautions.Students MUST obey all rules of the Student Leadership Experience and Pine Summit Camp.
Things you should know:
- There are Men's, Women's, and Gender Neutral cabins; there are staff cabins.
- Choose your own rooms, there is a sign-up master list in each cabin.
- No switching cabins after applications are submitted.
- Bathrooms are used by everyone during the day; from 11 p.m. - 8 a.m. Gender only
- Orientation - Camp rules will be communicated.
- Homework, no Wi-Fi, Limited cell service
- Refer to your lanyard info sheet for all activities and events.
Students should consider bringing:
- Minimum of 2 bags, no more than 3 bags.
  1. Clothes/Hygiene products
  2. Bedding
  3. School work
- Comfortable clothes - no eccentric, be appropriate, sweaters, jackets, flashlight, etc.
- Personal hygiene: shower shoes, toothbrush, toothpaste, shampoo, soap, wash cloths, towel, toiletries items, etc.
- Personal water bottle
- Snacks (OPTIONAL) - we provide lots of food and snacks but if you want specific ones, please feel free to bring them.
- Bedding: pillow, sheets, blanket, sleeping bag, etc.
- Can I bring?
I, First Name Last Name , understand that I must complete the Field Trip Waiver Form. You can pick up the form at the Lone Tree Campus, Room 111, The Club room, The Crater! See Derik Yellowhair for the form.
Should be Empty: