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Please complete this form by providing the names of your student chapter leaders and other pertinent information.

Filing the Student Chapter Information Form is a requirement to maintain your student chapter's active affiliation with SHRM for the current academic year. This form also notifies the national student programs office of any changes in advisors and/or chapter officers and indicates eligibility to participate in the Student Chapter Merit Award Program.

This form should be submitted no later than 11:59 pm ET, September 30, unless you are a new or reactivating chapter. (If you are unsure of your chapter’s current status, please email SHRMStudent@shrm.org for assistance.)

Please use full names, addresses, and formal titles (e.g., John Doe, Ph.D., SPHR, Professor) and fill the form out as completely as possible. Required fields are starred below. Please notify SHRM immediately of any changes in your chapter information.

Student Chapter Information * Student Chapter Name: * Student Chapter Number:     If you do not know your chapter number, search the online student chapter directory. * Student Chapter City: * Student Chapter State:     Student Chapter Website:

Student Chapter Primary Advisor * First Name: * Last Name: Credentials: (Ph.D., SPHR, etc.)     * Address:   * City: * State: * Zip Code:       * SHRM Member ID #: * Phone: (XXX)-XXX-XXXX * E-mail Address:

Student Chapter Co-Advisor (Optional) First Name: Last Name: Credentials: (Ph.D., SPHR, etc.) Address: City: State: Zip Code: SHRM Member ID #: Phone: (XXX)-XXX-XXXX E-mail Address:

Student Chapter President (SHRM National Student Membership Recommended) First Name: Last Name: Address: City: State: Zip Code: SHRM Member ID #: Phone: (XXX)-XXX-XXXX E-mail Address:

Sponsoring Professional Chapter Chapter Name: Chapter Number: Chapter City: Chapter State: Chapter Liaison Name: (College Relations Volunteer) Chapter Liaison Phone: (XXX)-XXX-XXXX Chapter Liaison E-mail:

University Representative Person we should notify of your chapter's accomplishments and your service to the students (e.g., dean, university president, department chair.) First Name: Last Name: Title Credentials: (Ph.D., SPHR, etc.) Address: City: State: Zip Code:

Upon submission of this form, a copy will be mailed to the email address listed within the Primary Advisor section. This will serve as verification that your form was received.

* I verify that the information provided above is correct to the best of my knowledge.