ST.

XAVIER’S COLLEGE, MUMBAI

EXTRA -CURRICULAR COMMITTEE 2022-23

APPLICATION FORM

1. Name of Student:
2. UID No.
3. Contact Number:
4. Email id:
5. Class & Stream:
6. CGPA (Minimum 8.5) –
7. Attendance (Must meet Minimum requirement of 75%)
8. Course Backlog - No course Backlog.
9. Social Involvement (If any, apart from the mandatory SIP hours) – (Certified Proof),
10. Past Experience (if any) of ECC/college society/college fest. – (Certified document):

Any other noteworthy achievement/organizational skill:

11. Give your preference in the table mentioned below:

Position Order of
Preference
1. Cultural Secretary
2. Student Coordinator, Admin
3. Student Coordinator, PR
4. Student Coordinator, Fine Arts
5. Student Coordinator, Literary Arts
6. Student Coordinator, Learning for Life
7. Student Coordinator, WPA dance
8. Student Coordinator, WPA Music
9. Student Coordinator, IPA Dance
10. Student Coordinator, IPA Music
 11. Contingent Leader (Malhar-2021/Any other
festival))
12. Assistant Contingent Leader
(PA, LA, FA, Informals)

13. X-Press (College Newsletter) – Editorial team

Note: ONLY upto 3 positions can be indicated in order of preference.

12. Vision Statement:

I certify that the information provided by me is true to the best of my knowledge and
in case, any discrepancy is found at any stage, I am liable for disqualification from that
post and appropriate action by the College Authorities for the offense committed by
me.

Signature of Applicant with date