1. First Name 
2. Middle Initial
3. Last Name
4. University ID
5. Mailing Address
6. City 7. State 8. Zip
9. Current Phone 
10. Summer Phone (in case we need to contact you) 
11. E-mail (if summer e-mail is different, please also include that address)

12. Have you ever applied to take this course?
Yes No

13. What year in school will you be in Fall, 2005? (please check only one):
Sophomore
Junior
Senior

14. Please list the campus and community organizations with which you have been and plan to be involved. Describe the nature of the organization and the nature of your involvement, particularly leadership positions you currently hold or will hold in the Fall of 2005.

15. Please write a few paragraphs explaining (a) what you can contribute to the learning environment (what can others learn from you), and (b) what you hope to get from the course.

16. Please briefly comment on your impressions of the importance of leadership in our diverse global community.

To register electronically, hit the "submit" button when completed.