EmailMe Form - NH Application

Unique ID

Personal Information

Name *

First MI Last

Email *

Date of Birth *

MM / DD / YYYY

Address *

Street Address City State / Province / Region Postal / Zip Code

Cell Phone *

### - ### - ####

Parent/Guardian Name *

Parent/Guardian Email *

Parent Cell Phone *

### - ### - ####

Member Name

Relationship to Member

School Information

High School *

Italian Level *

College *

Major *

Minor

Future Italian Studies

How many years to you plan to continue studying Italian at the undergraduate level?

Transcript Contact information

Guidance Counselor *

Guidance Email *

Italian Activities

Are you a member of your schools Italian Club? *

Yes

No

Club does not exist

Did you ever hold a leadership role in Italian Club? *

No

Yes

if yes please list your role.

Did you participate in any other Italian related activities?

Did you participate in any other Language clubs or activities?

Presentation

See instructions above for slideshow requirements

Slideshow link *

include a PUBLIC link to your slideshow

Disclosure

Checkbox *

By signing below and submitting this application I certify that the information provided in the application is truthful and accurate, and has been completed solely by the applicant.