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 within its activities.
Race:     Ethnicity:
National Origin:    Gender: 
Religion or Belief System (if any): 
Class Year: 2013 2012 2011 2010
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 Monday, November 23 at 10am, 1pm and 6pm. Should an unavoidable scheduling conflict present itself, I am responsible for notifying program staff to request a meeting to receive the missed information;
• Submit a $25 deposit that I will forfeit if I drop out of the program after Tuesday, December 22, 2009;
• Be present for the entirety of the Allies Institute and abide by all the community rules while participating in the program.