Application

Fill out the online application or download one.
The starred (*) fields below are required.

Enter School, Teacher & Chaperone Information:
A. School Name*:
1. Teacher's Name*:    
Subjects Taught:    
Email Address*:    
       
2. Teacher's Name:    
Subjects Taught:    
Email Address:
 
1. Chaperone's Name:
2. Chaperone's Name:

Enter Student Information:
First Name Last Name Age Ethnicity (optional)
1.
2.
 
3.
4.
 
5.
6.
 
7.
8.
 
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10.
 

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UConn EDP
(c) 2004 Uconn Engineering Diversity Program