SUMMER SCHOLARS PROGRAM REGISTRATION FORM

Please provide the following information to complete your registration for the Summer Scholars Program.

Questions may be directed to Ben Williams, Assistant Director for the Regnier Institute for Entrepreneurship and Innovation, williamsbenj@umkc.edu.

YOUR NAME AND CONTACT INFORMATION

Your name *:

Home address line 1 *:

Home address line 2:

City *:

State *:

Zip *:

Your email address *:

Your phone number *:


ENROLLMENT INFORMATION

Which UMKC school are you or will you be attending?

If Other please explain:

Are you a current or new student to UMKC?

What year in school will you be in the fall semester?


PLEASE TELL US WHY YOU ARE INTERESTED IN THE SUMMER SCHOLARS PROGRAM

How did you hear about the Summer Scholars Program?

What do you hope to achieve with the Summer Scholars Program? (200 words or less)