Student Chapter Application

Academic Year

Fall

Spring

Institution Name*

Academic Departments, Colleges, and/or Schools at your institution concerned with any aspect of design, construction, engineering, planning:*

Faculty Advisor

Faculty Advisor – Name*

First Last

Title

Department

Address*

Street Address Address Line 2 City State ZIP Code

Office Telephone

Email*

Department Website (If available)

Date Faculty Member Joined DBIA*

Name

First Last

Academic Major

Expected Graduation Date

Email

Name

First Last

Academic Major

Expected Graduation Date

Email

Name

First Last

Academic Major

Expected Graduation Date

Email

Name

First Last

Academic Major

Expected Graduation Date

Email

Completed by (First and Last Name):*

Chapter Role*

Date*

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)