SHAC Application
The Student Health Advisory Committee (SHAC) has many responsibilities that include assisting students in making healthier decisions, promoting student health care needs and the Lafene Student Health Center. SHAC works closely with the Director of Lafene Student Health Center in matters regarding student health care services, health service fees, and health insurance coverage.
All Kansas State University students are eligible to apply. Each elected board member will serve a term equivalent to one (1) academic year. Terms of office are from January to December. Each member is expected to attend all SHAC meetings, with a maximum of two absences of meetings per semester.
Please type or print clearly all information submitted on this application.
Name:__________________________________________ Date of birth:__________________
E-mail:_______________________________________ Phone:____________________
Local Mailing Address:_____________________________________________________
Permanent Mailing Address:_________________________________________________
Major:_______________________________ GPA:_______ Anticipated Date of Graduation:____________________
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 how will you contribute to the
committee?
3. Please list your extracurricular activities, hobbies, and/or special projects.
4. List your other time commitments, e.g. student organization, school, work.
By placing my initials here (__________), I DO NOT consent to have my photo used in marketing, educational and promotional 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 Lafene Health Center, Health Promotion, Room 268.
If you are selected for an interview, you will be contacted by phone. 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 healthy@k-state.edu.
01/2012