Participation Request
First Name:
Last Name:
Email Address:
Phone:
WCSU Status
Faculty
Staff
Student
If Student, please give WCSU ID:
Dept/Major:
Please give us information on the proposed project or activity. Describe what it is and/or what it's called.
Please identify the location for this activity.
When will this event take place?
What are your goals for participation?
If this activity is connected to a specific course of study, what is the course number/name and which faculty member is involved?
What other comments would you like to make to explain why you want to participate?
Contact Information