Update Form

SAN Member Form

Welcome to the State Authorization Network (SAN).

We are pleased that you will be part of the State Authorization Network (SAN). 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.edu. We look forward to having you as part of the network!

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

*1. Please indicate: the contact information for the 1-3 coordinators' per your membership type.

Higher Ed. Office, State Portal Entitles, Companies & Organizations * (Office Only)	1 Coordinator
1 Institution	2 Coordinators
2 - 15 Institutions	2 Coordinators
16+ Institutions	3 Coordinators

Coordinator #1

Membership Name*

First Name*

Last Name*

Job Title*

Organization*

Address*

City*

State*

Zip*

Email*

Phone Number*

(xxx) xxx-xxxx

Coordinator #2

First Name

Last Name

Job Title

Organization

Address

City

State

Zip

Email

Phone Number

(xxx) xxx-xxxx

Coordinator #3

First Name

Last Name

Job Title

Organization

Address

City

State

Zip

Email

Phone Number

(xxx) xxx-xxxx

2. Please provide the single point of contact for the membership Invoice:

Billing Information*

Use Coordinator #1 information Use Coordinator #2 information Use Coordinator #1 and #2 information Use Other

First Name

Last Name

Job Title

Organization

Address

City

State

Zip

Email

Phone Number

(xxx) xxx-xxxx

Do you have more than 10 institutions*

Yes No

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

Name of Institution #1

Member of WCET?

Type of Institution

FTE

Contact First Name

Contact Last Name

Contact Title

Email