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Requesting New Organization Shell

Organization's Information

*Required Fields

* Organization's Name

* Duration

*Accessibility

*Nature of Organization

*Nature of Membership

Leader's Information

The Organization's Leader * Required Fields

* First Name

*Last Name

*Phone Number
( ) - *ext :
* Email Address

Administrator's Information

Administrator with Rights to Enroll Users into the Organization
*leave blank if same as Leader

First Name

Last Name

Phone Number
( ) - *ext :

Email Address

Additional Comments

Lewis University is authorized to operate as a postsecondary educational institution by the Illinois Board of Higher Education.