MLK Leadership Summit 2010 Application Form The MLK Leadership Summit is a weekend retreat that runs from Friday, February 26, 2010 at 4:30pm - Sunday, February 28, 2010 at 4:00pm. The deadline to apply is Wednesday, February 10, 2010. Name: Phone Number: Local Address: E-mail: Year of Graduation: Major/School: Where do you live? On-Campus in Residence Hall Off-Campus Do you have a dining meal plan? yes no Food Allergies/Dietary Needs: Accessibility Needs/Accommodations: T-shirt Size: Small Medium Large X Large XX Large XXX+ Large [We will do our best to accommodate your request, but we cannot guarantee that you will receive the size you indicated above.] How did you hear about the MLK Leadership Summit? DEMOGRAPHICAL INFORMATION [Please share only what you feel comfortable disclosing to us. Your responses will not be shared with anyone except the OMSA professional staff.] Sex: Gender: Race: Ethnicity: Sexual Orientation: Nationality: Religious/Spiritual Traditions: Ability: Please take time to answer the following questions, which will assist us in our planning. There are no right or wrong answers; we simply want to know about your own individual experiences and insights. What is your definition of diversity? What is your definition of leadership? How do you see diversity and leadership related? What (or how) might you uniquely contribute to the MLK Leadership Summit? At this point in your life, which social identity (or identities) do you identify with or think about the most? [For the purposes of answering this question, social identities include, but are not limited to: race, ethnicity, gender, sex, sexual orientation, ability, class, religious/spiritual affiliation, and nationality.] For more information, please contact: Otis Douce, Multicultural Coordinator Office of Multicultural Student Affairs (MUB 327) 603-862-4528 otis.douce@unh.edu
Name:
Phone Number:
Local Address:
E-mail:
Year of Graduation:
Major/School:
Where do you live? On-Campus in Residence Hall Off-Campus
Do you have a dining meal plan? yes no
Food Allergies/Dietary Needs:
Accessibility Needs/Accommodations:
T-shirt Size: Small Medium Large X Large XX Large XXX+ Large [We will do our best to accommodate your request, but we cannot guarantee that you will receive the size you indicated above.]
How did you hear about the MLK Leadership Summit?
[Please share only what you feel comfortable disclosing to us. Your responses will not be shared with anyone except the OMSA professional staff.]
Sex:
Gender:
Race:
Ethnicity:
Sexual Orientation:
Nationality:
Religious/Spiritual Traditions:
Ability:
What is your definition of diversity?
What is your definition of leadership?
How do you see diversity and leadership related?
What (or how) might you uniquely contribute to the MLK Leadership Summit?
At this point in your life, which social identity (or identities) do you identify with or think about the most? [For the purposes of answering this question, social identities include, but are not limited to: race, ethnicity, gender, sex, sexual orientation, ability, class, religious/spiritual affiliation, and nationality.]
For more information, please contact: Otis Douce, Multicultural Coordinator Office of Multicultural Student Affairs (MUB 327) 603-862-4528 otis.douce@unh.edu
