SAN Member Form


Welcome to the State Authorization Network (SAN).


We are pleased that you will be part of the State Authorization Network (SAN) for SAN Year 6. The following survey should only take a few minutes, but will provide the necessary information for communication and interaction that makes being a member of SAN beneficial to your institution. If you have any questions about the membership form, contact Cheryl Dowd at 303-541-0210 or cdowd@wiche.eduor Marianne Boeke at 303-497-0357 or marianne@nchems.org. We look forward to having you as part of the network!


Click on the DIRECTIONS link for instructions to complete the form.


*1. Please provide the name of the membership (i.e., institution name, partnership name, or system name, etc.) and the two membership coordinators' contact information:



Coordinator #1

(xxx) xxx-xxxx

Coordinator #2

(xxx) xxx-xxxx

2. Please provide the contact information for the membership invoice:

(xxx) xxx-xxxx

For shared membership please provide any additional contact information for the invoice unless it is going to the Coordinator #1 and #2 information?

(xxx) xxx-xxxx

3. Please provide the names and contact information of the institutions that are part of this membership.

If your SAN membership includes 10 or fewer institutions, plese complete the fields below then scroll to the bottom of the form to submit.

If you have more than 10 insitutions download this excel file then send the completed file by email to Cheryl Dowd at cdowd@wiche.edu. You may submit responses to section 1 and 2 by scrolling down and hitting Submit.

Thank you for your help to capture all of our member information!

If you have more than 10 insitutions download the excel file from above and follow the above instructions. If you have less than 10 institutions please complete the bottom section unless you are an insitution of only 1

1


2


3


4


5


6


7


8


9


10