SENATE CANDIDATE REGISTRATION FORM

ELECTION 2013

PLEASE ATTACH COMPLETED PETITIONS, SIGNED COPY OF ELECTION RULES, and OFFICIAL TRANSCRIPT TO THIS
FORM AND SUBMIT TO THE ELECTIONS COMMITTEE, STEWART CENTER G06, BY 5:00PM ON MARCH 4, 2013

General Information
NAME:

__________________________________________________

PHONE:

( ___________) _____________________________________

E-MAIL:

____________________________________________ @ purdue.edu

LOCAL ADDRESS:

__________________________________________________
__________________________________________________

Candidacy
COLLEGE:

__________________________________________________

ACADEMIC CLASSIFICATION:

Freshman
Junior

MAJOR(S):

Sophomore
Senior or above

__________________________________________________

CUMULATIVE GPA: ___________ / 4.00