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Application

This application is used to notify students of upcoming Diversity Resource Center events, or events related to your course of study.

Please note that if you would rather mail in your form or drop it off at our office, we have a Application Form (.pdf) available.

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• Last Name:
• First Name:
• Middle Initial:
• Bengal ID #:
• Gender:
• Male
• Female
• E-Mail Address:
• Ethnicity:
• Street Address:
• City:
• State:
• Zip Code:
• Phone:
• Cellphone:
• Major:
• Level in School:
• Freshman
• Sophomore
• Junior
• Senior
• Graduate

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