Mosaic Application: New Member Application

Page 1 of 3

Thank you for your interest in becoming a Mosaic organization. Please take a moment to review the major characteristics of a Mosaic Organization before you fill out this form to ensure your organization may qualify. Note that if your application is approved, your organization will become a provisional Mosaic organization.

Name (or proposed name) of Organization

Host College (if applicable at this time):

Have you identified a member of the faculty or staff who might want to help you build this organization as an advisor?

YesNo

Faculty Advisor (if applicable at this time):

Which of the three Mosaic Organization characteristics do you think your organization has? Please select all that apply.

My organization is student-run and offers disciplines and skills that benefit the university's entrepreneurship community.My organization is committed to multidisciplinary collaboration, responsive client service and excellence in every product or service offering.My organization provides services that directly support the incubation of individual ventures that serve as our clients.

Please expand on why you selected the above answer(s) for the characteristics of a Mosaic organization.

Please describe the basic purpose or mission for your organization.

What sparked the interest in creating this organization?

Over the course of the semester or activity, who will be the best contact for your organization?

Name

Phone Number

Email Address

Page 2 of 3

Please list the current officers of the organization. Include the students' Name, College, Major, & Year of Graduation

How many members are currently in your organization?

What is the makeup of the membership of your organization? Examples might include colleges, majors or years of graduation represented.

Please provide an estimate of how many students are required to operate your organization.

Do you think that this organization will be something that students will rally around and want to get involved with in the future? If so, please provide context as to why.

Page 3 of 3

Describe what progress you have made in planning this organization.

If applicable, please include information regarding officially organizing with the Center for Student Involvement or the Graduate Student Council, drafting bylaws, etc. Note that you do not need to have the information above to become a provisional Mosaic organization. This helps us understand the development of the organization to date.

What have you completed thus far to develop a funding plan or a budget?

Note that you do not need to have the information above to become a provisional Mosaic organization. This helps us understand the development of the organization to date.

Have you finalized what services your organization will offer ventures and/or other Mosaic organizations? If so, what will those services include?

What are the goals of your organization for the next year and how will you measure success?

Have you collaborated with other groups in Mosaic or on campus? If so, how?

Contact Information