Student Moderator Application « National Collegiate Honors Council

General Information

Name

FirstLast

Institution

Address

Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry

Preferred Email (now - August 31)

Preferred Email (August 31 - November 6)

Mobile Phone

Summer Phone

School Phone

Honors Director Name

FirstLast

Honors Director Phone

Honors Director Email

Major

Minor

Subject Areas of Interest

Number of Honors Courses Completed

Number of Years in the Honors Program/College

Have you ever attended other NCHC Annual Conferences? (please specify)

Have you ever attended a City as Text™ session at a previous NCHC meeting? (please specify)

Have you ever attended one of the five regional association conferences that hold Business meetings at the NCHC conference? (please specify)

Have you ever attended an Honors Semester sponsored by NCHC? (please specify)

Will you be available to moderate the first session, beginning at 8:30am on Friday, November 8th?

Will you be available to moderate the last session, ending at 10:30 am on Sunday, November 9th?

Title of 2013 NCHC conference presentation (if applicable)

Special Notes