STUDENT AFFILIATE MEMBER APPLICATION — Center for Character & Citizenship

sTUDENT AFFILIATE MEMBERSHIP APPLICATION

PERSONAL INFORMATION

Name

First Name

Last Name

City

State

ZIP Code

Phone

(###)

###

####

Email

UMSL INFORMATION

Note: You must be a current UMSL graduate student to become a Student Affiliate of the Center for Character and Education.

Which degree program are you currently enrolled in?

What is your interest in the Center for Character and Citizenship? Why do you want to be an Affiliate?

Is there anything else you would like to add?

A CCC staff member will be in touch with you after you submit the application. Please e-mail us at ccc@umsl.edu if you have any questions.