First Name: Last Name: Student ID Number: Program(s) of Study: Phone Number: Email: Why would you like to participate in the Student Leadership and Diversity Conference? Please indicate which (if any) of the following student support services you utilize: Disability Services Gateway Promise Learning Success Coaches Multicultural program Non-traditional Occupations program StepUp program TAG - TRiO Achiever"s Group Veterans Support Services I"m not in a support program Do you plan to attend a March 21 campus Leadership Institute? March 21 – Elkhorn Campus Leadership Institute March 21 – Kenosha Campus Leadership Institute March 21 – Racine Campus Leadership Institute I do not plan to attend a campus Leadership Institute Do you plan to attend the March 22 – Gathering of Leaders on the Kenosha Campus? Yes No Transportation Transportation will be provided from the Racine and Elkhorn campuses to the Kenosha Campus on March 22. Please indicate if you need transportation: Bus Transportation I need transportation from the Racine Campus I need transportation from the Elkhorn Campus I do not need transportation Gateway Technical College is committed to providing access and equal opportunity for all. Gateway Technical College is committed to providing access and equal opportunity for all. Reasonable accommodation are provided for all services, programs, activities, education and employment for individuals with disabilities. Please let us know if you need ADA accommodations for any of the events. I need ADA accommodations for the Leadership Institute on March 21 I need ADA accommodations for the Gathering of Leaders on March 22 I do not need accommodations CAPTCHA Submit