| Submitter's Name (REQUIRED): |
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| Submitter's Title (REQUIRED): |
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| Dept. or Organization (REQUIRED): |
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| Submitter's Email (REQUIRED): |
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| School Name, Campus & Acronym (REQUIRED): |
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| ASGA Member? |
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| Campus Media Type |
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| Campus Media Name: |
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| Campus Media Nickname: |
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| Campus Media Address: |
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| Campus Media City: |
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| Campus Media State & ZIP: |
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| Campus Media Phone: |
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| Campus Media Fax (if any): |
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| Campus Media Email: |
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| Campus Media Web Address: |
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| Campus Media Publishing or Broadcast Frequency: |
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| SG Funds This Campus Media? |
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| Percentage Funded by SG: |
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| Actual Funding Amount: |
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| Campus Media Corporate Structure: |
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| Campus Media's Influence: |
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| Details (please write two or three paragraphs about this particular campus media, how it impacts the campus, its strengths and weaknesses, etc.): |
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| Social Media: |
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