First Name (as will appear on name tag)

Last Name

Position/Title

Institution

Address

City, State, and Zip Code

Telephone

Fax

Email

Project (check all that apply):

Gender:

Male Female

 

Number of Years in TRIO:

 

Please indicate your ethnic/racial background (use Ctrl button to select more than one):

American Indian African American Latino/ Hispanic/ Chicano/ Mexican American Asian American Pacific Islander Caucasian Other (please specify below)

Other:

ASPIRE Training Grants does not discriminate on the basis of race, sex, religion, disability, or national origin. The above information is optional and is gathered for reporting purposes only.

Please indicate your preferred training site:

(We will try to accomodate your selection and will notify you if that is not available.)

 

Orlando, Florida

The Castle Doubletree

February 24-26, 2000

 

Providence, Rhode Island

The Providence Biltmore

March 23-25, 2000

 

Kansas City, Missouri

Embassy Suites

April 27-29, 2000

 

Portland, Oregon

Embassy Suites

May 25-27, 2000

 

 

Please list any special accomodations/ dietary needs:

 

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Roommate information (skip this area if not applicable):

 

I would like to add my name to a list of participants who want to share a hotel room to offset costs. ASPIRE Training Institute will send me a list of all participants who would like to share rooms. This will be mailed one month before the room block deadline.

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Additional Comments:

You will receive confirmation of this application within 14 days. If you experience difficulty with this form or any aspect of ASPIRE Training Institute's website, please contact us. You can also obtain a printable form here. Please see our privacy statement if you have concerns about the information gathered here.

 

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