University of Minnesota: Multicultural Center for Academic Excellence

Multicultural Civic Engagement Program

Please use this form to sign up as a participant for the Civic Engagement Program.

First Name:

Last Name:

Student ID:

E-mail:

Address:

City:

State:

Zip Code:

School Address

Number of credits enrolled for Fall 08:

Phone Number:

Cumulative GPA:

Year in school:

Freshmen

Sophmore

Junior

Senior

College of Acceptance

What is the best way to reach you?

What does Civic Engagement mean to you?

Why are you interested in this program?

What do you consider to be your three greatest strengths?