Chapter Application

Chapter Contact Info

Chapter Name *

Institution *

Chapter Email (if applicable)

Chapter webpage (if applicable)

Primary Advisor

Either Primary Advisor or Co-Advisor must be a faculty member.

First Name *

Last Name *

Title/Position

Email Address *

Telephone Number *

Fax Number

Mailing Address *

City *

State *

Zip *

Co-Advisor

Either Primary Advisor or Co-Advisor must be a faculty member.

First Name

Last Name

Title/Position

Email Address

Telephone Number

Fax Number

Mailing Address

City

State

Zip

Student Representative

Must be an undergraduate student currently enrolled at the institution.

First Name *

Last Name *

SEEDS Chapter Position/Role *

(President, Co-President, Vice-President, Secretary, etc.)

Email Address *

Telephone Number *

Primary Phone Number

Address *

City *

State *

Zip *

Campus Address *

City *

State *

Zip *

Alternative Telephone Number

Class Standing

if other, please describe

Major

Minor/Concentration

Anticipated Graduate Date

Degree to be Obtained at Graduation

If Other type of degree, please explain

General Members

Please upload a table (as an EXCEL .xlsx file) of Chapter members including: First Name, Last name, email address, major, and graduation date for each student member. Please indicate Chapter officers in the spreadsheet. *

Maximum file size: 51.2MB

Chapter Mission

Please describe the purpose of your Chapter. *

Why is your group seeking to become a SEEDS Campus Ecology Chapter? *

How will your Chapter demonstrate commitment to the mission and goals of SEEDS? *

Chapter Activities

If the student group applying to be a SEEDS Chapter was preexisting, please describe past activities:

Please describe your proposed activities for this or the upcoming academic year: *

Please also attach any relevant Chapter photos or other documents

Maximum file size: 51.2MB

Chapter Certification

Report completed by:

Last Name

First Name

Certification

I have read and checked this report for omissions and errors. To the best of my knowledge, the information in this report is complete and accurate. I understand that the inclusion of false information or the failure to report all information requested in this report may disqualify our Chapter and its members from further opportunities with the Ecological Society of America’s SEEDS Program. As a SEEDS Campus Ecology Chapter, we will continue to serve the mission of SEEDS - to promote ecology opportunities for students, particularly those underrepresented in the science, to stimulate and nurture their interest, in order to diversify and advance the field of ecology.

The Chapter Advisor, Co-Advisor, and Student Representative agree to the above:

Yes

No

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