Student Chapter Application Form

NSMA Charter Application Form

On behalf of the students whose names are listed below and in accordance with the regulations governing the establishment of a student Chapter of the National Sports Media Association, the undersigned hereby petition the Board of Directors of the National Sports Media Association, Inc., for a grant of a charter to be known as a Chapter of the National Sports Media Association.

School

Full Address

Accredited By

Required Courses

The following are the media courses included in the college curriculum, names of teachers conducting them, and credits granted for each course:

Courses allied to the journalism/media sequence at our institution are:

Students

Student members of the proposed Chapter are (attach extra pages if necessary):

Name Email Graduation Date

1. __________________________________ _______________________________________ _______________

2. __________________________________ _______________________________________ _______________

3. __________________________________ _______________________________________ _______________

4. __________________________________ _______________________________________ _______________

5. __________________________________ _______________________________________ _______________

6. __________________________________ _______________________________________ _______________

7. __________________________________ _______________________________________ _______________

8. __________________________________ _______________________________________ _______________

9. __________________________________ _______________________________________ _______________

10. __________________________________ _______________________________________ _______________

11. __________________________________ _______________________________________ _______________

12. __________________________________ _______________________________________ _______________

13. ­__________________________________ _______________________________________ _______________

14. __________________________________ _______________________________________ _______________

15. __________________________________ _______________________________________ _______________

16. __________________________________ _______________________________________ _______________

17. __________________________________ _______________________________________ _______________

18. __________________________________ _______________________________________ _______________

19. __________________________________ _______________________________________ _______________

20. __________________________________ _______________________________________ _______________

The petitioning students listed on this application understand that if the NSMA grants them a charter, they will, upon notification, forward a single check to NSMA National Headquarters representing $45 annual national dues for each student, or $1,000 for as many students who want to participate. Do not collect or forward dues to Headquarters before the charter is granted.

Faculty Advisor

Proposed Faculty Advisor ___________________________________________________________________________

Address ________________________________________________________________________________________

Phone _______________________ E-mail _____________________________________________________________

Signature of Proposed Faculty Advisor ________________________________________________________________

To be completed by the NSMA Executive Director and two NSMA Board members.

NSMA Endorsement/Approval

The NSMA Board of Directors and the NSMA executive director, by virtue of the signatures below, hereby approve the above application for an NSMA charter.

NSMA Executive Director (print) _________________________________ Signature ____________________________

NSMA Board Member (print) ___________________________________ Signature _____________________________

Date: __________________