Name: 
UR ID#:
UR Box # or Off-campus Address:
Residence Hall:   Room#: 
Phone:    Cell Phone:
Email: 
T-shirt size: 

How did you hear about the Allies Institute?
 


Demographic Information
This information will be used to ensure a diverse representation of backgrounds at the Allies Institute and will only been seen by the program directors.
Race:     Ethnicity:
National Origin:    Gender: 
Religion or Belief System: 
Class Year: 2011 2010 2009 2008
Are you a transfer student? yes no
Do you consider yourself part of the LGBT community? yes no

What groups are you a part of at UR?
 

Statement
Describe why you want to attend the Allies Institute and what you hope to get out of the program.

• Attend one of the mandatory orientation sessions to be held on Friday, November 30 at 11:30am, 1pm and 4pm.

• Submit a $25 deposit that I will forfeit if I drop out of the program after Thursday, December 20, 2007;
• Be present for the entirety of the Allies Institute and abide by all the community rules while participating in the program.