Women in Leadership
Participant Application
March 1, 2008

Thank you for your interest in the Women in Leadership Conference.

(*denotes required fields)

This form has several parts. The last section of the form asks a series of questions which may require some thought. We recommend reviewing the form to familiarize yourself before completing. After submitting the form, you will be asked to download a signature page which must be returned to the Center for Student Leadership & Involvement before your application is considered complete.

PART I
Name*
Name as you prefer it on your nametag*
Campus/Local Address*
Local Telephone Number*
Cell Phone Number (optional)
Email Address*
IM Screen Name
May we include your contact information on a roster to be distributed to all participants ?*
Yes No
Please tell us about yourself.
Do you identify as* Male Female Transgender

Other
This information is used for rooming assignments. Since this application is not confidential and may be viewed by a committee for participant selection, students who do not identify as male or female may contact Kelly Stevens in the Center for Student Leadership and Involvement at Ithaca College in order to address rooming assignments and to maintain confidentiality.
Educational Insitution*

Class Standing*

School (Check all that Apply)*
Ithaca College
Cornell University
Hobart & William Smith
University of Rochester
Wells
Other: 		First Year
Sophomore
Junior
Senior
Grad 		Business
Communications
Humanities & Sciences
Health Sciences & Human Performance
Inderdisciplinary & International Studies
Music
Major*
Please help us prepare for your participation
Emergency Contact Name*
Relationship*
Telephone Number*
Are there any special needs as defined by the Americans with Disabiltiies Act (ADA)? Information provided here is intended to assist facilitators to appropriately prepare for participation.*

No Yes
If yes, please explain
Dietary Concerns*
None Vegetarian Vegan Kosher

Food Allergies, please explain

Other:
Did you attend last year's Women in Leadership Experience? *
Yes No
How did you hear about this program?
Part II: Please respond to the following questions.*
1. Briefly explain why it is important to nurture women as leaders?

2. What challenges do you feel you're facing in your leadership experiences?

 

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