University of Central Florida
Nontraditional Student Association

Supported in Part by:

Membership Form
No cost or obligation


Information from this form will be compiled and published for our annual directory. This allow our members to get to know each other sooner and will reflect who we are as an association. If you do not wish to be contacted by other members or listed in the directory, you must state so on this form. This may be copied for others to make contact with you.

Name:
Address:
City:
Zip:
Phone:
Major:
Expected Graduation Date:
Class: Undergraduate Graduate Doctoral Staff

New Transfer?: Yes No
If so, from where?

Do you need a roommate?: Yes No
Do you have a room available?: Yes No

Maritial Status: Single Married
Spouse's Name:
Children's Names and ages:
1.
2.
3.

Do you need child care referral?: Yes No
Can you offer child care services?: Yes No

Do you have a debilitating medical condition?: Yes No

Temporary or Permanent: Temporary Permanent

Do you need assistance with the condition?: Yes No

Employer:
Position:
Do you need a job?: Yes No

Are you involved with any other activities at UCF?: Yes No
If so, what are they?

Would you like to participate on any NSA committee?:
Membership
Programs
Activities
Promotions
Lobbying

Do you have a home computer?: Yes No
Platform: Macintosh IBM
Do you have a modem?: Yes No
Do you need help with computers on campus or home?: Yes No

Please rank by order of preference reasons for joining NSA. 1 being the highest or most important.

To increase my professional development:
To socialize with my peers:
To relate with others in my circumstances:
To get more out of campus services:
To be referred to community resources:
To meet people I might commute with:
To meet people I might share child care with:
To be a part of UCF student life:
To do professional networking:
To find people to date: