SEAHO

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RELI Form

The timeline for applications will be:

Applications Open – NOW
Application Deadline – March 12th, 5:00pm EST
Successful Applicants Notified – April 1st

First Name:

Last Name:

Mailing Address:

Office Number:

Email:

Cell Number:

Position Title:

Institution:

Type Institution:

Length of Time in Current Position:

Total length of time in professional full-time positions:

State of Institution:

Size of Institution:

Race/Ethnicity (Optional):

What do you hope to gain from attending RELI ?
A value is required.Exceeded maximum number of characters.

What are your professional goals for the next 3-5 years?
A value is required.Exceeded maximum number of characters.

Please submit a current resume:
:

Please attach a letter of reference and support from your
Director of Housing or Director of Residence Life
(higher level supervisor or CHO):

The following questions relate to conference logistics and possible scholarship awards should you be selected as a RELI 2010 partipant --

What is your T-shirt size: ____

What, if any, special accomodations would you require to participate in RELI:

What, if any, special meal needs would you have (ie: food allegies, vegetarian option needed):

Scholarships are available for SEAHO participants. Please answer the following questions to determine your qualifications for a scholarship award --

Which best classifies your financial need:

I would be self-funded for RELI 2010

My institution would fund my registration and travel costs

Scholarship requests:

Registration Waiver

Travel Reimbursement