MLK Leadership Summit 2009 Application Form The MLK Leadership Summit is a weekend event held off-campus that runs from Friday, February 20, 2009 at 3:00pm - Sunday, February 22, 2009 at 4:00pm. The deadline to apply is Wednesday, February 11, 2009. Name: Phone Number: Local Address: E-mail: Year of Graduation: Major/School: 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 King 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 King 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:
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 King 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 King 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
