ASEEES Initiative for Diversity and Inclusion Information Form

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Last Name

First Name *

Institution/Professional Affiliation (If none, indicate none) *

Preferred Email *

I am eligible for this program because (Select all that apply): *

I identify as BIPOC

I am a current first-generation undergraduate student

Required

I identify as (Select all that apply): *

African American/black

Asian, Asian American, Pacific Islander

Hispanic, Latin(a/o), Latinx

Native American

White

Other

Required

Are you a current or former member of ASEEES? *

Yes, I am a current member

I am not a current member, but have been a member in the past

No, I have never been a member

I am already an ASEEES member. I do not need a complimentary membership.

Required

How did you hear about this ASEEES program?

ASEEES Email

ASEEES Website

Social Media

Other

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Additional Comments

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