Student Health Advisory Committee
Committee Member Application
The Student Health Advisory Committee (SHAC) has many responsibilities, including helping to promote student health care, the Lafene Student Health Center and Counseling Services. SHAC also works closely with the directors of Lafene Student Health Center and Counseling Services in matters regarding student health care needs, health service fees, and health insurance coverage.
Each Spring Semester, new student members are appointed to serve two-year staggered terms on the committee. By filling out and returning this application, you are completing the first step in the selection process. Current SHAC members interview those students whose applications are selected for further consideration, and the student body president makes the final appointment of new members to SHAC.
Please type or print clearly all information submitted on this application.
Name:__________________________________________ Date:__________________
E-mail:_______________________________________ Phone:____________________
Local Mailing Address:_____________________________________________________
Permanent Mailing Address:_________________________________________________
College:___________________________ Major:_______________________________
Class ranking for next school year:
Freshman:_____ Sophomore:_____ Junior:_____ Senior:_____ Graduate:_____
Other please specify):___________________________________
Anticipated Date of Graduation:____________________ Cumulative GPA:_______
Total estimated number of hours in class per week for next school year:_______
Total estimated number of hours working per week for next school year:_______
Please answer the following questions as completely as possible.
1. What are your educational and professional goals?
2. What motivated you to apply for a position on SHAC, and what do you feel you can contribute as a member of SHAC?
3. Please list your activities, hobbies, and special projects.
4. Please list your honors and awards.
By placing my initials here (__________), I DO NOT consent to have my photo used in marketing, educational andpromotional material, to include web site, display and printed brochures, produced for Lafene Health Center.
If necessary, answers may be continued on a separate sheet of paper. Please feel free to attach references, your resume, or other supporting material. Return this application to the Office of Student Activities and Services, on the Ground Floor of the K-State Student Union by 5:00 p.m. on the second Friday in April.
If you are selected for an interview, you will be contacted by phone in April. If you are not selected, you will be notified by mail.
If you have any questions, please call 785.532.6595 or send an e-mail to shac@k-state.edu.
10/2008
