Pan African Student Association -l- Miami Dade College

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PASA Online Application
Please fill out the form completely. Various federal, state, local and college laws prohibit discrimination based on race, color, sex, religion, nationality, ancestry, age, disability or marital status. PASA is an equal opportunity organization and your response to any question will not be used as a basis for discrimination, but will be judged on its relevance to the type of membership you are seeking. To expedite your application, please complete all required fields Below. All fields marked in bold are mandatory.
PASA Believes in you... Do You?

PASA...Making twice the Noise

Things You Should Know

The Pan African Student Association do not process any incomplete application. The first thing to do before you are considered as an active member of PASA is to fill and complete an application.

All non-faculty ( Students) must be registered in at least 6 credit hours per semester with a GPA of 2.00 or higher.

All fields marked on red are are mandatory.

APPLICANT INFORMATION

Salutation:

Name:
	(Last)	(First)	(Middle Initial) Optional

Student or SS#:	- - This is needed for the student life record
Gender:	Male Female Date of Birth:
Street Address:	Line 1
Street Address:	line 2 (Optional)
City:		State:	Zip Code: (5 digit)

Country of Birth:

Home Phone:	Cell Phone:	Alternate Phone:

Email:

Alternate Email:


Your Biography:		Not Less Than 200 Words
	All Bios must be screened by the publicity committee. We do not guarantee posting exact Bio as submitted. There may be alterations to correct grammatical errors, spelling, etc. It must not be more than 1500 words long. Bio must contain your Nationality, Major, personality, and why you want to be a member of PASA.

APPLICANT EDUCATIONAL INFORMATION

This Section Applies to Current Students Only

Current Campus:

Degree Program:
If Other please specify:
Program/Course of Study:
If Other Please specify:
Expected Graduation Date:	Month: Year:

Already Graduated:
Number of Credits Currently Registered:
GPA:	.

Are you involved in other Organizations?
If Yes, List your current organizations:	1st Organization
	2nd Organization
	3rd Organization

EMERGENCY CONTACT INFORMATION

Name:
	(Last)	(First)

Street Address:	Line 1
Street Address:	Line 2 (Optional)
City:		State:	Zip Code: (5 digit)
Phone:
Email:
Relationship:

MEMBERSHIP

Please select only one membership type (for more information about membership, Click Here)
	Current Student	Alumni	Faculty / Staff	Prospective Student

SPECIAL OFFERS

SIGN UP FOR PASA NEWSLETTER?	Yes No
WOULD YOU BE ABLE TO ATTEND PASA MEETING EVERY TUESDAY AT 2:00 PM ?	Yes No
WOULD YOU LIKE A PASA REPRESENTATIVE TO CONTACT YOU?	Yes No
WOULD YOU LIKE TO RECEIVE A FREE UBUNTU CD SOFTWARE? For More Information about Ubuntu, Click Here)	Yes No

How Did You Learn About PASA?

END USER LICENSE AGREEMENT

I affirm that the above information is true to the best of my knowledge. I authorize the Membership Committee of the PAN AFRICAN STUDENT ASSOCIATION of Miami-Dade College, to verify any information required to process my membership. By submitting this form, I affirm to know the responsibility of being a member of the Pan African Student Association of Miami Dade College.

DO YOU ACCEPT OUR USER AGREEMENT?	Yes No

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