Department of Residence Life
Freshman interest survey information request Form
Purpose: The Freshman Interest Survey (FIS) asks students to identify areas of new interest or prior involvement. It is introduced during summer Odyssey and optional for students to complete. The information can be used to engage students in campus life, promote specific activities, or to recruit membership based on an expressed student interest.
Guidelines: Upon receiving information from the FIS, users must adhere to the following:
· Information may be used only to promote involvement in the stated organization or department specifically listed below.
· If a student indicates s/he wishes to no longer be contacted, remove him/her from the list immediately. In addition, please inform Lori Develice Collins of the request for removal.
· This information may not be distributed to all student organization members or department employees, but only to those listed below. It is the responsibility of the individual completing this form to educate these individuals of our expectations.
Procedure: Submit your request to Lori Develice Collins at or Department of Residence Life, 263 S. Gruenhagen Hall. Once approved, the main contact will receive an excel document to the email account listed below, containing student names and local addresses for each individual interest request. The Department of Residence Life reserves the right to deny requests for information. Please allow 10-14 days.
Please PRINT legibly.
CONTACT INFORMATIONStudent Organization/Department:
Contact Name:
Position/ Title:
Preferred Email: Preferred Phone #: ( )
Individuals within your organization/department that have been granted access to this information:
Name, position Email
Name, position Email
Name, position Email
Student Organizations ONLY
Advisor Name:
Position/ Title:
Preferred Email: Preferred Phone #: ( )
INFORMATION REQUESTWhat will this information be used for? Example: Recruiting for a Diversity Committee.
Who is your target audience?
Residence Hall Students Only Commuter Students Only All
Identify below the lists you are requesting:
Community Involvement
Badger Boys/Girls Work with Children Environmental Issues Habitat for Humanity
Blood Drives Campaign/Elections Work with Animals Philanthropy/Community Service
Multicultural Clubs/Involvement
American Indian African American Hispanic Gay, Lesbian, Bisexual, Ally
Asian Hmong Religious Affiliation International Student Association
Journalism/Media Involvement
Student TV Station Student Radio Station Student Newspaper Staff Media/AV Club
Hobbies
Gaming Photography Computer/Video Games Website Development
Student Government
Class Officer Fundraising Leadership Activities/Event Planning
Leadership Seminar/Conference Planning
Recreational Activities
Rock Climbing Rollerblading Water Skiing Weight Lifting
Hiking Aerobics Camping Rugby
Snow Boarding Volleyball Softball Bowling
Academic Clubs
Math Club Computer Club Debate Club Science Club
SIGNIATUREI understand that failure to adhere to the above stated guidelines may result in disciplinary action, and agree to respect the rights of our students while working to get them involved on campus. After use, I will shred or delete the document(s) received by all individuals designated above.
Signature Date
Please return this form to Lori Develice Collins, Assistant Director of Residence Life, at or Department of Residence Life, 263 S. Gruenhagen Hall. Call (920) 424-3212 with any questions.