JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Virginia Tech & Clemente Veteran's Initiative: Spring 2023
Registration form for the Clemente Veteran's Initiative humanities course.
The course will take place on Monday and Thursday evenings from 6:30 to 8:30 pm. We are offering it online.
If you have questions, please email one of the instructors: Jack Cheng <jack.cheng@gmail.com> or Jim Dubinsky <dubinsky@vt.edu>.
* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Phone number
*
Your answer
Year of Birth
*
Your answer
Highest education level
*
Some high school
High school or GED
Some college
Associates degree
Bachelor's degree
Post-graduate degree
Military Branch (if applicable)
*
Army
Navy
Air Force
Marines
Coast Guard
Military family member
Other:
Required
Dates of military service (if applicable)
*
Your answer
Do you have any learning-related needs for which you might need accommodation (hearing, sight, mobility)? If so, please provide details below.
*
Your answer
Why are you interested in this course? Please write a paragraph describing the reason(s) why this class appeals to you.
*
Your answer
Because the sessions are online, will you have a computer and a good internet connection?
*
Yes
No
Are there any questions you'd like us to answer?
*
Your answer
What would be the best time to call you for a follow-up conversation?
*
Weekday day
Weekday evening
Weekend day
Weekend evening
A copy of your responses will be emailed to the address you provided.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
