Student Chapter Application Academic YearFall SpringSpring Institution Name* Academic Departments, Colleges, and/or Schools at your institution concerned with any aspect of design, construction, engineering, planning:* Faculty AdvisorFaculty Advisor - Name* First Last Title Department Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Office TelephoneEmail* Department Website (If available) Date Faculty Member Joined DBIA* Student Chapter PresidentName First Last Academic Major Expected Graduation Date Email Student Chapter Vice PresidentName First Last Academic Major Expected Graduation Date Email Student Chapter SecretaryName First Last Academic Major Expected Graduation Date Email Student Chapter TreasurerName First Last Academic Major Expected Graduation Date Email To be individually signed by Faculty Advisor and Chapter OfficersCompleted by (First and Last Name):* Chapter Role* Date* MM slash DD slash YYYY Required Attachments An electronic copy of Student Chapter Roster (in Excel) with full contact information for minimum of six students; information required is name, email and estimated graduation date. Note that this roster must be sent in bi-annually to National by October 30 and February 28 Proposed Student Chapter Academic Year Budget Original copy of signed Student Chapter Constitution (countersigned copy will be returned to Chapter) Questions: Contact DBIA at (202) 682-0110 or membership@dbia.org
