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Student Health Advisory Committee (SHAC) Application

Date«

Name«

Home/Dorm Phone«

Work Phone

Address«

City«

State«

Zip«

E-mail«

Year of School«

College«

Gender

Male

Female

Major«

Activities/Community Service, duration«

What previous experiences or ideas or qualifications will you bring to SHAC?«

What group of students will you represent on SHAC? How will you improve communicate with them?«

Please explain why you are interested in serving on SHAC«

Goals for SHAC involvement«

Future Career Goals«

Resume

No more than one side of one page

Fields marked with "«" are required.

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Loyola University Maryland | 4501 N. Charles Street, Baltimore, MD 21210
410-617-2000 | Weather Line: 410-617-2223

Loyola University Maryland | 4501 N. Charles Street, Baltimore, MD 21210
410-617-2000 | Weather Line: 410-617-2223