Institution (full name of college or university): *
Your answer
Are you a Professional or Student at your Institution?
Clear selection
Are you a current professional or student at an HBCU? *
Choose
Professional at an HBCU
Student at an HBCU
No
If you are a professional or student at an HBCU - Describe the importance of preserving and celebrating the cultural history of NIRSA and its foundation at HBCUs. (Limit 500 characters)
Your answer
Do you identify as a person of color?
Choose
Yes
No
NIRSA Region: *
Choose
Canada
Region I
Region II
Region III
Region IV
Region V
Region VI
Do you identify as LGBTQIA? *
Choose
Yes
No
If you answered yes to the above, explain what you have done as a member of the LGBTQI community or as an ally to advance social justice in collegiate recreation. (Limit 500 characters)
Your answer
Will you receive any financial institutional support to attend NIRSA 2021 Virtual?: *
Choose
Yes
No
Gender Identity:
Your answer
Have you been accepted as a session presenter at at NIRSA 2021 Virtual conference? *
Choose
Yes
No
Are you a current NIRSA member? Membership is not required to apply for a scholarship, but is required to redeem a scholarship. *
Choose
Yes
No
A copy of your responses will be emailed to the address you provided.