STUDENT DIRECTORY INTAKE SHEET- NEW CANDIDATES

A S L A
University of California Los Angeles Extension, Student Chapter


STUDENT DIRECTORY INTAKE SHEET- NEW CANDIDATES
The information provided here will be used by the Student Chapter/ASLA (SCASLA), aka Landscape Architecture Student Association (LASA), solely for the purpose of creating a Student Directory to facilitate communication within the student body of the UCLA Extension Landscape Architecture Program. Those items checked will not be published in the Student Directory, but will be available to the SCASLA elected officers solely for communication purposes regarding SCA business. If there is any information you do not want available to the SCASLA elected officers, do not include it on this form. However, you must include at least one E-mail address and one phone number. Please return this in the SASE provided. Please print clearly.
Check here if you do not want the item to appear in the Student Directory

Name: _______________________________________________________

Address: _____________________________________________________

City: ________________________________________________________

State: ________________________________ Zip Code: ______________

Home Phone: _________________________________________________

Work Phone: __________________________________________________

Cell Phone: ___________________________________________________

Home E-Mail: _________________________________________________

Work E-Mail: _________________________________________________

I am interested in volunteering for the following: (check all that apply)
( ) Student Show
( ) Providing Graphics or Word Processing Services
( ) Fundraising
( ) Assisting With Organizing Events or Activities
( ) Providing Technical Assistance for Internet / Web Communications
( ) Writing Articles for, or Editing the HAPPENINGS Newsletter