Apply to be a SHAC Member

SHAC Application

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

Year in School(Required)

Gender(Required)

Age(Required)

Ethnicity

Status(Required)

Check any of the following areas you are or have been involved with as a participant or employee:

ASCSU/Student Organizations

Fraternity and Sorority Life

Residence Halls (work or live in)

Apartment Life

Diversity Offices

Explain why you are interested in being a member of the Student Health Advisory Council. Include what skills, abilities and experiences you will bring to the Council.(Required)

Please share what you know about the CSU Health Network programs and services provided for students.(Required)

Please provide the names, phone numbers, and email addresses of two professional references and how you are associated (former supervisor, supervisor, advisor, professor, etc.).(Required)

Colorado State University

CSU Health Network

General Medical Services

Speciality Medical Services

Overview of Mental Health Services

No Referral/Screening Required

Internal Referral/Screening Required

About Health Insurance

Student Health Insurance

Private Health Insurance

About

Student Support

Involvement and Education

SHAC Application

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Physical Address

Mailing Address

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