SIXTH COLLEGE ORGANIZATION REGISTRATION FORM

SIXTH COLLEGE ORGANIZATION REGISTRATION FORM
*Completed registration Form includes pages 1-2; PLUS a Constitution
Name of Organization: _____________________
Organization is:
New
Date: ____________
Updating Information
Re-registering
Primary Focus (Please Check ONE only):
Academic
Cultural
Co-Ops/Enterprise
Educational
Media
Political
Recreation
Religious
Service
Social
Other
Purpose of Organization (Mission Statement):
Primary Contact Information:
Primary Contact: ______________________________________________________
Phone: _____________________
Email Address: ___________________________
Position within Org: ____________________________________________________
Advisor:
Advisor Name:________________________________
Phone: _____________________
Mail Code: ______________
Email Address: ___________________________
Advisor Signature: __________________________
Advisor Position: ___________
Members (A minimum of three are required):
1. Name (Print First & Last ): _________________________________________
Phone: __________________
Email: _____________________________
Member Signature: ______________________________________________
Position within Org: ______________________________________________
2. Name (Print First & Last ): _________________________________________
Phone: __________________
Email: _____________________________
Member Signature: ______________________________________________
Position within Org: ______________________________________________
3. Name (Print First & Last ): _________________________________________
Phone: __________________
Email: _____________________________
Member Signature: ______________________________________________
Position within Org: ______________________________________________
4. Name (Print First & Last ): _________________________________________
Phone: __________________
Email: _____________________________
Member Signature: ______________________________________________
Position within Org: ______________________________________________
5. Name (Print First & Last ): _________________________________________
Phone: __________________
Email: _____________________________
Member Signature: ______________________________________________
Position within Org: ______________________________________________
6. Name (Print First & Last ): _________________________________________
Phone: __________________
Email: _____________________________
Member Signature: ______________________________________________
Position within Org: ______________________________________________
*Upon signing the form, the Members hereby give permission for their
names and e-mail to be given out as contacts for their organization.
Review:
Notes:
Approved
Needs Revisions (See Notes)
Denied (See Notes)
Reviewed By:
Date:
SIXTH COLLEGE STUDENT ORGANIZATION INDEMNIFICATION FORM
We, the membership of _______________________________________________________ do hereby agree
to comply with the University of California policies and procedures and UCSD CAMPUS REGULATIONS APPLYING
TO CAMPUS ACTIVITES, ORGANIZATIONS AND STUDENTS, which includes but is not limited to:
COMPLIANCE WITH STATE AND FEDERAL LAW
The University of California, in compliance with Titles VI and VII of the Civil Rights Act of 1964, Title IX of the
Education Amendments of 1972, Sections 503 and 504 of the Employment Act of 1967, and the Age Discrimination Act of 1975, does not discriminate on the basis of race, color, national origin, religion, sex, handicap or age
in any of its policies, procedures, or practices; nor does the University,
in compliance with Section 402 of the Vietnam Readjustment Act of 1974, the section 12940 of the in compliance with Section 402 of the Vietnam Readjustment Act of 1974, the section 12940 of the State of California
Government Code, discriminate against any employees or applicants for employment because they are disabled
veterans or veterans of the Vietnam era, or because of their medical condition (as defined in Section 12926 of
the California Government Code), their ancestry, or their marital status; nor does the University discriminate on
the basis of sexual orientation. This nondiscrimination policy covers admission, access, and treatment in
University programs and activities, and application for a treatment in University employment.
No student, student organization, or other person attending UCSD shall knowingly commit, participate in, or
conspire to commit in any manner, acts of hazing. Hazing includes any method of initiation or pre-initiation into
a student organization or any pastime or amusement which causes, or is likely to cause, bodily danger, physical
harm, or personal degradation or disgrace resulting in physical or mental harm to any student or person attending UCSD (as per Sec. 32050-52, CEC).
UNIVERSITY NAME
A registered campus/student organization shall not use the name of the University of California or
abbreviations thereof as part of its name except in accordance with the campus regulations. The
geographical designation “at UCSD” may be used by any campus/student organization as part of its
name without obtaining special approval.
The name, insignia, seal, or address of the University may not be used in any manner, political, or
otherwise, which implies that the University supports or agrees with any of the activities, positions,
purposes, ideals, or goals of any individuals, groups, or organizations acting within these regulations.
MEMBERSHIP
Only registered UCSD students may hold office in the organization.
Only registered UCSD students may vote in elections for the selection of the organization’s officers.
Faculty, staff, and community members may participate in the activities of registered UCSD student organizations.
The University shall not prevent the organization from retaining or using legal counselor from selecting a representative as provided for in any UCSD disciplinary or grievance procedure.
INDEMNIFICATION
The registered student organization and its members agree to indemnify and hold harmless the Regents, the
University, its officers, agents and employees from and against any and all claims, unless due to willful or
negligent acts or omissions of the University.
SIGNATURE OF PRINCIPLE MEMBERS
1._______________________________
6._______________________________
2._______________________________
7._______________________________
3._______________________________
8._______________________________
4._______________________________
9._______________________________
5._______________________________
10.______________________________