Journey into Leadership: Oh the Places You'll Go!
16th Annual WV TRIO Student Leadership Conference
Registration must be completed by February 24th, 2017
The conference registration fee covers ALL meals, entertainment and conference materials.
The cost is $100 per person for registrations received by February 24th, 2017.
Registrations received after February 24th will be charged at a rate of $150 per person.
Refunds, minus a $25 administrative fee per registered attendee, are available through
March 1st, 2017.
No refunds will be issued after March 1st!
Contact Person Office Phone Number
Contact Person Office Cell Number
Educational Opportunity Center
Educational Talent Search
Math/Science Upward Bound
Ronald E. McNair Program
Student Support Services
Veterans Upward Bound
Provide a mailing address for your program/organization:
Each program must have a minimum of one chaperone for every 10 students. All chaperones are required to register for the conference and must attend events with his/her students. Chaperones are responsible for the actions of their attendees!
Please list the names of chaperones that will be in attendance. Hit ENTER after each name.
Please list shirt sizes for ALL chaperones attending the Student Leadership Conference. Shirt sizes available are: Small, Medium, Large. Extra Large, XXL and XXXL.
Please list the dietary needs or accommodations for any chaperones in attendance. Type N/A if no accommodations are needed.
Please complete the information below for our records. If you make changes to the students who will be attending after February 24th, we can not guarantee that shirt size accommodations can be made.
Please list the names of program participants that will be in attendance. Hit ENTER after each name.
Please list shirt sizes for ALL program participants attending the Student Leadership Conference. Shirt sizes available are: Small, Medium, Large. Extra Large, XXL and XXXL.
Please list the dietary needs or accommodations for any program participant in attendance. Type N/A if no accommodations are needed.
We are excited to offer the opportunity for each program to have a group photo taken in front of a green screen with the TRIO Logo and/or Conference Logo. You will receive your photo immediately to take back and share with your students. To be efficient, we want to have a scheduled time for each group so that long waits do not occur. With this in mind, please select your top three time choices below and we will inform you of your scheduled time prior to the start of the conference.
Please indicate your top three schedule choices for a group photo:
Please indicate how you will be paying for your attendance at the conference. An invoice will be sent based on your final number of conference registrations.
How will you be paying?
Credit Card (purchase card)
Never submit passwords through Google Forms.
This form was created inside of Heart of Appalachia Talent Search Program.
Terms of Service