Name * First Name Last Name Email * Phone * (###) ### #### What university or college do you attend and want to start a UAID chapter at? * What year are you in? * Freshman Sophomore Junior Senior Graduate School Other What degree are you seeking? What are you majoring in? * Why are you interested in UAID specifically? * Please include a discussion on how you identify with the mission, values, and philosophy of UAID. (200 word limit) What leadership or other experiences/skills do you have that prepares you to start and lead the Chapter? * (200 word limit) Describe any prevalent health issues that you've observed or are aware of in your surrounding campus community. * (200 word limit) Do you currently know of or volunteer with any community organizations that address the health issues you described above? Please list the organization(s) and explain your role if any. * (200 word limit) Describe the process of becoming recognized as an official student organization at your university. * Please describe any experience you may have with this process. (200 word limit) Have you considered who would be the university advisor to help support the Chapter? Please explain. * (200 word limit) How many hours per week would you be able to commit to the Chapter? * Please list the contact information (name and e-mail) for up to five potential Chapter leaders. Type N/A if none. * Is there anything else you would like to add to your Chapter application? * By checking this box, I certify all information is true and correct to the best of my knowledge. If selected, I also agree to follow the CHNA model in designing our community project to ensure that the quality and integrity of our project meets community needs. * Thank you for your submitting your application to start a new chapter of UAID on your campus! We will review your submission and get back to you shortly. NEW CHAPTER APPLICATION