MD Student Organization Officer Report

Your officer report must be updated no later than the third Monday of the start of Fall classes AND any time information changes or your group elects new officers.

Group Information

Student Organization Name

Location

Date of most recent elections

Organization's website

Officers

Please list the President, Vice President, Treasurer, Secretary and Faculty Advisor. Organizations must have a President, Treasurer and Faculty Advisor at a minimum. No co-officers permitted. Please be aware that this information is public knowledge. If you have request to be on the confidentiality list, please notify Amy Bockis at abockis@pennstatehealth.psu.edu.

Position Title

Name

Penn State email address

Certification

By typing the names below, you certify that the list of officers above is correct and were elected according to the procedures spelled out by the Constitution of the group. Typing the names below constitutes an electronic signature.

The president affirms that the organization will abide by Penn State University's non-discrimination AD-42 policy.

Organization President

PSU Email Address

Faculty Advisor

PSU Email Address

Date

Contact Information