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Major:

Classification:

Are you Hispanic or Latino? (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race)

Please select the racial category or categories which you most closely identify. Check as many as apply.

Vegetarian Lunch Required?

How many Cockrell School of Engineering Student Division Student Leaders Conferences have you attended in the past?

For which leadership role(s) have you been invited to attend this year's Student Leaders Conference?

On a scale of 1 (no role) to 7 (major role) how would you rate your leadership role(s) in the Cockrell School? (How influential or important do you feel your role is within student leadership in the Cockrell School?)

What level of understanding do you feel you have regarding Cockrell School of Engineering Resources?

What level of understanding do you feel you have regarding University Resources?

What leadership role(s), if any, do you serve within your Student Organization(s)?

Consent and Waiver Form*
The following release is required so that the Cockrell School of Engineering may take pictures and/or video tape during our event: I hereby grant full permission to The University of Texas at Austin to prepare, use, reproduce, publish, distribute and exhibit my (or my student's) name, picture, portrait, likeness or voice, or any or all of them in or in connection with the production of web sites, still photography, motion picture film, television tape, film or sound track recording, scientific publication for informational or any other professional purpose deemed necessary in the interest of the mission of The University of Texas at Austin. I hereby waive all rights of privacy or compensation for me (or my student), which I (or she/he) may have in connection with the use of my (or her/his) name, picture, portrait, likeness or voice, or any or all of them, in or in connection with said web sites, still photography, motion picture film, television tape, film or sound track recording and any use to which the same or any material therein may be put, applied or adapted by The University of Texas at Austin. This consent and waiver will not be made the basis of a future claim of any kind against The University of Texas at Austin and any of its agencies. By indicating 'Accept' on the registration form, I am agreeing to the terms set forth in the above Consent and Waiver. Questions may be directed to the Women in Engineering Program (WEP) at 512-471-5650. UT Austin Web Privacy Statement: http://www.utexas.edu/policies/privacy/

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