Strategic Leadership Training Application
If you are interested in participating in the Office of Diversity and Inclusion's Strategic Leadership Training, please fill out the following information.
Name:
*
First Name
Last Name
Preferred Name:
*
First Name
Last Name
Pronouns:
*
Race:
*
Gender:
*
DawgTag:
*
SIUxxxxxxxxx
Date of Birth:
*
-
Month
-
Day
Year
Date
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SIU Email:
*
Preferred Phone Number:
*
-
Area Code
Phone Number
How do you prefer to be contacted? (choose 1 or all depending on preference)
*
Text
Call
Email
Major:
*
Minor:
*
Are you involved with any Student Organizations or other extracurriculars on campus?
*
Yes
No
What are your long-term career objectives and how would the Strategic Leadership Training contribute to your attainment of these objectives? (Please answer in 100-300 words.)
*
0/300
Enter the message as it's shown. (This is to prevent spam)
*
Submit
Should be Empty: