Diversity - HOIST Sign Up Form

1.

First Name *This question is required.

Middle Initial

Last Name *This question is required.

Mailing Address *This question is required.

Apt/Suite/Office

City *This question is required.

State *This question is required.

Zip *This question is required.

Email Address This question requires a valid email address.

Home Phone

Mobile Phone

Gender

Birth Date *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Tribe

If you've entered a tribe, are you enrolled?

Are you enrolled as a student at U of I?

2. What is your shirt size?

3. How did you hear about the HOIST program?

Tell us about yourself ...