- Reporting Student & Project Performance
- Application Form
- ---Please print this form and fax to (307) 755-5532---
Name_________________________________________________Male______ Female______ Position/Title ___________________________________________ Years in TRIO __________ Project(s): ( )SSS, ( )UB, ( )VUB, ( )MSUB, ( )EOC, ( )TS, ( )McNair Institution/Agency______________________________________________________________ Address_____________________________________________________________________ City/State/Zip_________________________________________________________________ Telephone (___)__________________________ Fax (___)____________________________ E-Mail_____________________________________________________________________ -
- Please indicate your ethnic/racial background:
- ____American Indian ____Asian American____Black/African American ____Pacific Islander
- ____Latino/Hispanic/Chicano/Mexican American ____Caucasian
- ____Other (Please Specify)_______________________________________________________
ASPIRE Training Institute does not discriminate on the basis of race, sex, religion, disability or national origin. The above information is gathered for reporting purposes only. - Please list any special accommodation/dietary needs: _________________________________
- I would like to have my name added to a list of participants who want to share a hotel room in order of offset costs. ____Yes, add my name and send me a list ____ No
If you are not the director of the project, please have your director approve your application: ____________________________________ _____________________________________ | Director’s Name | Director’s Signature | Fax this application to: (307) 755-5532 |