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                Student Health Awareness Club - SHAC

                              Membership Application
                                                   The membership is FREE and all RU students are eligible to apply.

 

  1. Name:              2. E-Mail:  

  3. Cell Phone              4. Home Phone

  5. Current Address :

  6. Home Address :

  7. Major :        8. Minor :       9. GPA :

  10. Have you ever been on Academic Probation?   Yes         No   

  11. When will you graduate?

  12. Why are you interested in joining SHAC?

  13. Please list your hobbies / extra-curricular activities

  14. Have you taken any classes related to health? (Enter 'Yes' or 'No')
       Training will be provided as needed.

   Nutrition       Sexual Health       Mental Health       Physical Activity

   Alcohol, Tobacco and other Drugs        Other

  15. What areas of health promotion would you like to help with? (Enter 'Yes' or 'No')

   Program Planning/Designing         Publicity/Advertising         Presentations

  16. What else would you like us to know about you? 

  17. Please provide your class-schedule or enter your time availability (on Monday - Friday) for    
       SHAC meetings and activities in Fall 2009.  (The club usually meets twice a month)
   
    

                                                                       

 

   
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