Application Deadline
Note:
You are encouraged to register early, as the spaces fill quickly.
Employees,
Students, and External Applicants:
Thursday, September 15, 2011
General Information for All Applicants
Last Name:
First Name:
Preferred First Name:
ID Type (If you are affiliated with NC State University, please use NC State ID Number):
Please select an
ID type...
Employee ID Number
Student ID Number
Other 9-Digit ID (Please make note
of your choice.)
ID Number:
Email:
Phone:
Fax:
Are you
an:
NCSU employee
NCSU student
Other (External Applicant)
*
Are you
a continuing EOI participant from a prior year?
No
Yes -
Please note: Continuing
participants do not need to attend EOI Orientation a second time.
How did you hear about the Institute?
* External (non-NCSU) applicants, please
note that there is a $500 registration fee due by September 15, 2011.
Please send payment to NC State University at the address listed at
the bottom of this form. Please write "EOI" in the memo
line of your check. There is no cost for NC State employees and students.
Accommodations for individuals with disabilities :
Individuals with disabilities desiring accommodations to participate
in these activities, please contact our office at least two weeks prior
to EOI Orientation. NCSU takes seriously its obligation to accommodate
the known disabilities of its faculty, staff, students, and guests.
Our goal is to make the campus a place where all can participate in
a barrier-free environment.
NCSU Employees Only Students and external applicants, please skip this
section.
College or Division:
Department:
Job Title:
Campus Box:
Supervisor's Last Name:
Supervisor's First Name:
Supervisor's Phone:
Supervisor's Campus Box:
NCSU Students Only Employees and external applicants, please skip
this section.
College or Division:
Department:
Student
Class Year:
Freshman
Sophomore
Junior
Senior
Grad Student
Major:
Local Mailing Address:
City:
State:
Zip:
External Applicants Only NCSU students and employees, please skip this section.
Organization:
Job Title:
Mailing Address:
City:
State:
Zip:
Supervisor's Last Name:
Supervisor's First Name:
Supervisor's Phone:
Supervisor's Mailing Address:
Choose Your Orientation Date
Thursday, September 8, 2011, 1:00-3:00 pm, First Floor Conference Room, Winslow Hall.
Friday, September 16, 2011, 1:00 pm - 3:00
pm, First Floor Conference Room, Winslow Hall.
Tuesday, October 11, 2011, 2:00 pm - 4:00
pm, Room 212, Winslow Hall.
I am a continuing participant and have attended
EOI Orientation in a prior year.
Obtain Your Supervisor's Approval - NCSU Employees Only
NCSU employees must obtain their supervisor's approval
to participate in EOI. Supervisors are required to attend the first
hour of EOI Orientation. Please notify your supervisor of the date
and time that you have selected to attend EOI Orientation.
I have obtained my supervisor's approval to participate
in EOI. (Employees must submit the EOI
Supervisor Approval Form .)
I have notified my supervisor of the date that I
have selected to attend EOI Orientation and have asked him/her to attend
the first hour.
Submit Your Registration
By submitting this form, you agree that you have read
and understood the program requirements and the nature of the Equal
Opportunity Institute and, if accepted into the program, commit to:
fully participating
in all components of the program;
attending all scheduled
courses;
actively engaging in
the learning process;
applying new knowledge
to your job, education, or involvement at NC State
attending EOI Orientation.
