Application for Executive Committee

If you have questions, please contact Dominic Clucas at (573)341-4280
or email him at dgcc64@mst.edu

1.  Basic Information

First Name
Last Name
Local Address
City
ZipCode
Phone
Email
Student ID Number
Major
Expected Graduation Date (YYYY-MM-DD)
Grade Level
Polo Shirt Size
If you plan to co-op, please indicate when
Number of Credit Hours Completed

2.  Additional Information

Other Campus Organizations involved in
(Please be sure to list any offices held and committees chaired)

Why do you feel you are qualified?

Please select which Committees you wish to serve on:

Committee Choice 1:

Committee Choice 2:

Committee Choice 3:

If you are applying for Web Administration committee please rate your proficiency in the following:

Windows Server System
HTML / XHTML
PHP / ASP.net / Perl / CGI
Adobe Flash / Adobe Photoshop

How many hours are you taking next semester?

How many hours a week do you expect to spend on your duties:

The Vice President of Internal Affairs will contact you regarding an interview time.