Department of Information Management
805-437-8552
Student Club/Organization
Web Site Registration Form
CSUCI student clubs or student organizations that would like to create and publish a web site at CSU Channel Islands must
complete this form, and obtain the signature of the Director of Student Leadership and Development.
Name of Student Club or Organization:
Type of Organization (check one): Club Organization
Student Club/Organization President Student Club/Organization Web Site Contact
Name: Name:
Phone: Phone:
Email: Email:
Student Club/Organization Advisor (if applicable) Club/organization web site is authorized to operate
for the following one academic year:
Name:
Phone:
Email:
Desired Web Site URL @ studentclubs.csuci.edu (e.g. http://studentclubs.csuci.edu/mathclub/):
http://studentclubs.csuci.edu/
Would you like your web site published in our
Club and Organization Web Site Registry (check one)
Yes No
Accepted By:
Signature of Student Club/Organization President Date
Signature of Director of Student Leadership & Development
Dat
e
Please submit signed and completed forms to Web Services, Broome Library 2675. Incomplete
forms will not be processed. Please contact Web Services at 805-437-3932 or via email at
webmaster@csuci.edu
with any questions.
For Office Use Only
Request Received by:
Date:
Web Space Created by:
Date:
