Membership Application

Please print this form. When you complete it, send it to the International Student Organization advisor:

Maria Shamyer
LB 232
West Windsor Campus
Mercer County Community College
P.O. Box B
Trenton, NJ 08690

If you have questions, call (609) 586-4800, ext. 3528 or 3527.

Name: _____________________________________________________________________

Address: __________________________________________________________________

___________________________________________________________________________

Home Telephone #: _____________   Work Telephone #: _____________

Date of Birth: ________________   Gender:  Male, Female  (circle one)

Country of Origin: ______________________________________________

Enrolled as a:  __ Full-time student (12 credits or more)
                __ Part-time student (up to 11 credits)

Academic Program of Study: ______________________________________

Number of Credits completed so far: ______

Number of Credits this semester: _______

Special Interests/ Hobbies: _____________________________________

Student's Signature: ____________________________________________

Today's Date: _______________________