Name

First Name

Last Name

Email Address

Student Number or LSPIRG Community Member Number

Proposed Working Group Name

Which Campus Will Your Group Be Located On?

Description of Proposed Group

How Does This Connect to LSPIRG's Core Values?

LSPIRG Values; Social Justice, Creativity, Learning, Collaboration, and Activism

How Does This Connect to LSPIRG's Mission?

Mission: LSPIRG empowers its members to foster social justice by providing learning opportunities, access to resources, and avenues for action

Goals / Perceived Outcomes of the Group

Projected Budget

Other Assistance Required from LSPIRG

I.e. graphic design support, help finding meeting space etc.

Research & Action Committee Application