INROADS REWARDS Program Organization Registration
Organization Name *
Ex: SACNAS - Society for Advancement of Chicanos/Hispanics and Native Americans in Science
Your answer
College Institution *
Ex: University of North Carolina or University of Texas (no abbreviations please)
Your answer
Organization/Institution Address *
Example: UCF, 4000 Central Florida Blvd
Your answer
City *
Your answer
State *
Adviser Name and title *
Example: Carr, Frank - Dean of Business or Smith, Jane Associate Professor
Your answer
E-mail *
Example: NSBE@UCONN.edu or UCLASHPE@gmail.com (Officially registered email at university preferred not required)
Your answer
Phone #
Example: (515-458-5555) If available, not mandatory
Your answer
Contact 1 Name *
Example: Smith, John J.
Your answer
Contact 1 Phone #
Example: (515-458-5555)
Your answer
Contact 1 E-mail *
Your answer
Contact 2 Name
Example: Smith, Jane
Your answer
Contact 2 E-mail
Your answer
Contact 2 Phone #
Example: (515-458-5555)
Your answer
Organization Social Media *
Choose all that apply
Required
List of social media links/handles. *
@NSBE or #SIUSACNAS or www. SHPE@UCF.edu or www.NSBE@CSU.edu
Your answer
How many active members are in the organization? *
Includes Executive Board
When are meetings held for general members? *
Example: Mondays 8pm to 9pm
Your answer
How did you learn about INROADS REWARDS *
Do you accept the terms and conditions of the INROADS REWARDS Agreement? *
Thank you in advance for helping make the INROADS REWARDS Program a success.We hope to share your experiences to ensure that the program continues to improve and better serve all who participate. Most of all, we look forward to working with you as we continue to promote the INROADS mission. Would you be interested in an INROADS presentation on your campus? *
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