Symposium on Diversity Registration

CURS Presentation Registration for Symposium on Diversity
Name

First NameLast Name
What institution are you from?
What is the name of the institution?
Phone Number
(000) 000-0000Format: (000) 000-0000.
Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Anticipated Graduation Date

MonthDayYear
Gender Identity
If you selected Other, please specify below:
Major
Current Class Standing
Current Cumulative GPA
How many students will be presenting?
Will this presentation be given by more than one student?
Who is the lead presenter?
Presenter Number One
Name

First NameLast Name
Student ID Number
Email Address
example@example.com
Presenter Number Two
Name

First NameLast Name
Student ID Number
Email Address
example@example.com
Presenter Number Three
Name

First NameLast Name
Student ID Number
Email Address
example@example.com
Presenter Number Four
Name

First NameLast Name
Student ID Number
Email Address
example@example.com
Presenter Number Five
Name

First NameLast Name
Student ID Number
Email Address
example@example.com
Student Presentation Category
Was this presentation part of an in-class assignment?
Course Title
Course Number
Name of Faculty Mentor

First NameLast Name
Email of Faculty Mentor
example@example.com
Phone Number of Faculty Mentor
(000) 000-0000Format: (000) 000-0000.
Department of Faculty Mentor
Name of Second Faculty Mentor

First NameLast Name
Email of Second Faculty Mentor
example@example.com
Phone Number of Second Faculty Mentor
Please enter a valid phone number.Format: (000) 000-0000.
Department of Second Faculty Mentor
How many faculty mentors were involved with this project?
Title of Presentation
Presentation Abstract
Should be Empty:

CURS Presentation Registration for Symposium on Diversity

Presenter Number One

Presenter Number Two

Presenter Number Three

Presenter Number Four

Presenter Number Five