Acs Student Affiliates Chapter

ACS STUDENT CHAPTER

REACTIVATION APPLICATION

Thank you for contacting us about reactivating your ACS student chapter. We are very pleased that you have decided to realign your chapter with ACS and we are here to help you get back on your feet! In order for us to update our records, please complete the information below. You must complete each section in order for your chapter to be reactivated. Once we receive this information and verify the number of paid student members in your chapter and verify that your faculty advisor is a member of ACS, you will receive a letter acknowledging that your chapter has been reactivated. Again, we thank you for taking the necessary steps to reactivate your ACS student chapter and we look forward to working with you.

ACS Undergraduate Program Staff

Institution: __________________________________________________________________

Address: __________________________________________________________________

__________________________________________________________________

Department Chair: ____________________________________________________________

Chapter Faculty Advisor: ______________________________________________________

ACS membership number: __________________________________________________

E-mail: _________________________________________________________________

Phone: _____________________________ Fax : _______________________________

Does your faculty advisor want to be included on the faculty advisor e-mail list? _____________

Chapter Co-Advisor: _________________________________________________________

E-mail: _________________________________________________________________

Phone: _____________________________ Fax : _______________________________

Does your co-advisor want to be included on the faculty advisor e-mail list? _____________

Chapter’s Web address: ______________________________________________________

Institution’s Web address: ______________________________________________________

Please list chapter officers.

President: ____________________________________________________________

Vice –President: ____________________________________________________________

Treasurer: ____________________________________________________________

Secretary: ____________________________________________________________

Please list at least six chapter members that are ACS student members and their numbers. You must have at least six paid student members in your chapter in order to be reactivated.

We submit this application to reactivate the ACS student chapter at

________________________________________________________________.

_______________________________ ____________________________________

Chapter President Date

________________________________ ____________________________________

Faculty Advisor Department Chair

For office use only

Date received: ____________________________________

Date reactivated: ____________________________________

Staff signature: ____________________________________

Rev. 4/15/2010