By submitting this form, I acknowledge that Illinois Tech has the right to contact me.AcceptCancelLeadership Symposium Alternative Participation Request FormLoading...This form is intended for students who are unable to attend the Leadership Symposium in person and are requesting approval for an alternative participation option. All requests are subject to review, and students will receive confirmation regarding approval status and any required next steps.Email AddressFirst NameMiddle NameLast NameBirthdateBirthdateJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember12345678910111213141516171819202122232425262728293031202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Mailing AddressMailing AddressCountryStreetCityRegionPostal CodeAre you currently registered for the in-person Leadership Symposium event? YesNoI don't knowPlease list any scholarships for which you have been nominated.Please list any scholarships for which you have been nominated.Camras Leadership ScholarshipEmerging Campus LeadersDuchossois Leadership Scholars ProgramCrown Scholarship ProgramM.A. Lila Self Leadership Academy ScholarshipI don't knowReason for request:Reason for request:Academic conflictSchool obligationHealth or wellness reasonCaregiving or family responsibilityTravel or transportation barrierReligious observanceOtherPlease briefly explain the reason for your requestVirtual Participation Date ConfirmationVirtual Participation Date ConfirmationYes, I understand that virtual option will be only on Monday, February 23, and I am able to participate on that date. I acknowledge that my virtual interview may be assigned to me at any time between 8am and 5pm CST on that date.Virtual Participation Date ConfirmationVirtual Participation Date ConfirmationIf my request is approved, I understand that virtual option will be sometime on or after February 19, and I will able to participate on that date virtually. I acknowledge that my virtual interview may be assigned to me at any time between 8am and 5pm CST on that date.You will receive confirmation of your interview date and exact time no later than two weeks prior to the interview.Submit
By submitting this form, I acknowledge that Illinois Tech has the right to contact me.AcceptCancelLeadership Symposium Alternative Participation Request FormLoading...This form is intended for students who are unable to attend the Leadership Symposium in person and are requesting approval for an alternative participation option. All requests are subject to review, and students will receive confirmation regarding approval status and any required next steps.Email AddressFirst NameMiddle NameLast NameBirthdateBirthdateJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember12345678910111213141516171819202122232425262728293031202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Mailing AddressMailing AddressCountryStreetCityRegionPostal CodeAre you currently registered for the in-person Leadership Symposium event? YesNoI don't knowPlease list any scholarships for which you have been nominated.Please list any scholarships for which you have been nominated.Camras Leadership ScholarshipEmerging Campus LeadersDuchossois Leadership Scholars ProgramCrown Scholarship ProgramM.A. Lila Self Leadership Academy ScholarshipI don't knowReason for request:Reason for request:Academic conflictSchool obligationHealth or wellness reasonCaregiving or family responsibilityTravel or transportation barrierReligious observanceOtherPlease briefly explain the reason for your requestVirtual Participation Date ConfirmationVirtual Participation Date ConfirmationYes, I understand that virtual option will be only on Monday, February 23, and I am able to participate on that date. I acknowledge that my virtual interview may be assigned to me at any time between 8am and 5pm CST on that date.Virtual Participation Date ConfirmationVirtual Participation Date ConfirmationIf my request is approved, I understand that virtual option will be sometime on or after February 19, and I will able to participate on that date virtually. I acknowledge that my virtual interview may be assigned to me at any time between 8am and 5pm CST on that date.You will receive confirmation of your interview date and exact time no later than two weeks prior to the interview.Submit
