Scholarship Dinner Registration

Please submit the online registration form below.

Banner ID *

First Name *

Last Name *

Email Address *

Cell Phone *

I will be attending the Scholarship Dinner on Tuesday, November 12, 2019 at 5:30 PM

Yes

No

If no please provide a reason

I require approval to miss my evening class.

Yes

No

If yes, please provide.

Name of professor :

CRN # :

Course number and section :

Class time :

I require special accommodations.

Yes

No

If yes, please indicate the nature of the accommodations required.

Dietary

Handicapped

Other

Questions about the Scholarship Dinner