AsUR Member Application
Thank you for your interest in AsUR. 

This Google Form Application has 3 sections:
  1. Student Contact Information
  2. Executive Functioning Challenges
  3. Next Steps and Statement of Intent

NOTE: Membership is not guaranteed. Applications that completed by a parent, family member, friend, or teacher and not by the student will not be considered. Dishonest or misleading applications will be subject to review and may not be considered.

For any Questions or Concerns, please contact: 
AsUR
asur@appstate.edu
(828) 262-6332 

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Email *
Legal Name *
First Middle Last
Preferred First Name *
Pronouns used *
Appstate Email *
(put NA if you do not have one yet)
App State Banner ID *
(starts with 900 or 901.  If you do not know it or do not have one yet, type NA)
Secondary/Personal Email *
Cellphone Number *
Date of Birth *
MM
/
DD
/
YYYY
How did you hear about AsUR: *
When you are interested in starting with AsUR: *
Required
My decision to attend App State is contingent on receiving AsUR support: *
Strongly disagree
Strongly agree
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