City of Hampton, Unity Commission, Diversity College Registration

Diversity College Application

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Hampton Diversity College - Level II Understanding & Managing Gay & Transgender Issues June 17 - July 1, 2010
*First Name:	*Last Name:
Nickname:
*Address:
City:	State: Zip:
*Daytime Phone:
*E-mail:
The following information is confidential and is requested only for the purpose of insuring that the class sessions are diverse.
*Job Title:	Department:
*Age:	Gender: Religion:
*How do you prefer to identify yourself racially?:
*Educational level achieved:
Indicate why you are interested in enrolling in the Hampton Diversity College:
What do you hope to gain or learn from participating in the Hampton Diversity College?:
Describe your involvement with other community and/or civic activities:
How did you hear about the Hampton Diversity College?:
Additional Comments: