SHARE MEMBERSHIP FORM

Name: ____________________________             Date: _________________

Year in School: (please circle one)

Major or Graduate area of study: _________________________

If graduate student, department: ______________ Academic Adviser: ________________

ISU Email: ________________________  Home Phone: ___________________________

Cell Phone: _______________________  Campus Address: ________________________

If a directory is published online, would you like to be in it?  Yes____ No_____

In the space below, please tell us why you are interested in joining SHARE:

What are you looking to get out of your experience working with SHARE?

 Do you have any trauma, disaster, or crisis intervention training? Please describe below.

Please list any relevant certifications (ex: Red Cross).