KCKCC Forms

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Student Senate Application

Please read the Student Senate Election Information PDF before you fill out the application.

This PDF will provide information on:

Qualification requirements
The election process and rules
Duties of senators
Information about of the executive office positions, i.e. president and vice-president

If you are human, leave this field blank.

Office Desired

Executive Committee Candidates

President

Vice-President

Secretary

Treasurer

Non-Executive Candidates

Activities Coordinator

Parliamentarian

Graphic Designer

Chief Information Officer

Personal Information

Candidate's Name *

Student ID Number *

Phone *

Address *

Apt, suite, etc.

Country

City

State

Zip code

Birthday *

Shirt Size *

Program *

KCKCC Graduation Year *

Are you involved with any other activities are you involved with at KCKCC or your current High School? *

Accumulative Grade Point Average *

Total Number of Credit Hours Earned *

Current educational status in Fall 2020: (Please Mark)

Freshman

Sophomore

High School Senior

Emergency Contact

Name *

Phone *

Relationship *

Employment

Are you currently employed? *

Yes

If yes, where?

Will you be working while in school?

If yes, how many hours per week?

Personal Reference #1

Name *

Phone *

Email *

Years Known *

Why did you choose this reference? *

Personal Reference #2

Name *

Phone *

Email *

Years Known *

Why did you choose this reference? *

Why would you like to be part of the Kansas City Kansas Community College Student Senate? *

Were you involved in any extra-curricular activities (i.e. leadership, clubs, etc.)? *

Please explain you answer to the question above *

I authorize Andrica Wilcoxen, Director of Student Activities at KCKCC to review my academic records for the purpose of confirming I have a 2.0 grade point average or higher

Signature *

Date *

Kansas City Kansas Community College

7250 State Ave | Kansas City, Kansas 66112 | 913-334-1110

KCKCC is an Equal Opportunity and Affirmative Action Educational Institution