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Getting to Know You
Welcome to VISTAs in the Piedmont! We collect basic information about you that isn't included in your application so that we can customize our program, activities, and trainings to best meet your needs. Please answer these questions thoroughly.
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* Indicates required question
Preferred first & last name
*
Your answer
What pronouns would you like us to use for you?
*
He/Him
She/Her
They/Them
Option 4
Best cell phone number to reach you?
*
Your answer
Best email to reach you? *We discourage using college emails because they are often deleted shortly after graduation
*
Your answer
Name of Emergency Contact
*
Your answer
Relationship to your Emergency Contact?
*
Your answer
Emergency Contact's phone number
*
Your answer
Emergency Contact's email address?
Your answer
When is your birthday?
*
MM
/
DD
/
YYYY
Are there any reasonable accommodations that we could provide to make learning/working easier for you? (ex. wheelchair accessibility, specific presentation/communication style, working with service animal, etc.)
Your answer
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