CURS Presentation Registration for Symposium on Diversity
Name
*
First Name
Last Name
What institution are you from?
*
Please select
BGSU
Other Institution
What is the name of the institution?
Phone Number
*
(000) 000-0000
Email Address
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Anticipated Graduation Date
*
-
Month
-
Day
Year
Date Picker Icon
Gender Identity
*
Please select
Woman
Man
Gender non-conforming/Gender Queer
Intersex
Trans Woman
Trans Man
Other
If you selected Other, please specify below:
Major
*
Current Class Standing
*
Please select
Freshman
Sophomore
Junior
Senior
Graduate Student
Current Cumulative GPA
*
How many students will be presenting?
*
Will this presentation be given by more than one student?
*
Yes
No
Who is the lead presenter?
*
Presenter Number One
Name
First Name
Last Name
Student ID Number
Email Address
example@example.com
Presenter Number Two
Name
First Name
Last Name
Student ID Number
Email Address
example@example.com
Presenter Number Three
Name
First Name
Last Name
Student ID Number
Email Address
example@example.com
Presenter Number Four
Name
First Name
Last Name
Student ID Number
Email Address
example@example.com
Presenter Number Five
Name
First Name
Last Name
Student ID Number
Email Address
example@example.com
Student Presentation Category
*
Please Select
Poster Presentation
Art Display
Musical Performance
Was this presentation part of an in-class assignment?
Yes
No
Course Title
Course Number
Name of Faculty Mentor
First Name
Last Name
Email of Faculty Mentor
example@example.com
Phone Number of Faculty Mentor
(000) 000-0000
Department of Faculty Mentor
Name of Second Faculty Mentor
First Name
Last Name
Email of Second Faculty Mentor
example@example.com
Phone Number of Second Faculty Mentor
Please enter a valid phone number.
Department of Second Faculty Mentor
How many faculty mentors were involved with this project?
One
Two
Title of Presentation
*
Presentation Abstract
*
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