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The University of Tennessee

Student Orientation and Leadership Development

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Registration


Dinner with Leaders Registration

Please be sure that you do not press enter any place before completing the form.
All fields are required unless otherwise specified.

Personal Information


Name:  Preferred Name: 
            Last             First
  
LOCAL Address:  (Building Name & Room # If On Campus)
City/State/Zip Code:    (37916 - On Campus & Fort Sanders)
  
E-mail:  Cell Phone Number:  (xxx)xxx-xxxx
  
Ethnicity:
Classification: Academic Major: 
  
  
Do you have any dietary restrictions? 

Are you a part of the Women’s Mentoring Network? 

What are you hoping to learn through this program? 


Please note: If you determine after registration that you will be unable to attend the Dinner with Leaders program, please email or call the Office of Student Orientation & Leadership Development at (865) 974-2313. Your cooperation will insure that waitlisted students are able to attend in your place.

By initialling below:

  • You agree that the information provided herein is true to the best of your knowledge; and
  • You agree to contact our office as stipulated above if you will be unable to attend the Dinner with Leaders program.

Initials: 

Disclaimer

The University of Tennessee does not discriminate on the basis of race, sex, color, religion, national origin, age, handicap or veteran status in provision of educational opportunities or benefits.

The University of Tennessee does not discriminate on the basis of sex or handicap in the educational programs and activities which it operates, pursuant to the requirements of Title IX of the Educational Amendments of 1972. Public Law 92-318; and Section 504 of the Rehabilitation Act of 1973, Public Law 93-112, and the Americans with Disabilities Act of 1990, Public Law 101-336, respectively.

This policy extends to both employment by and admission to the University. Inquiries concerning the Title IX and Section 504 and the Americans With Disabilities Act of 1990 should be directed to the Office of Affirmative Action, 2110 Terrace Avenue, The University of Tennessee, Knoxville, Tennessee 37996-3558 or call (865) 974-2498. Charges of violations of the above policy should also be directed to the Office of Affirmative Action.