UCS

ExCEL Interest Form

         

  Male    Female   

Contacting Me

I give permission for UCS to contact me or leave a message by the following means. I am aware that information exchanged over a cell phone and email could be intercepted by an outside party

Okay to call or leave a message if I am unavailable at:

Cell:    Residential:

Work:    Other:

Monday:   Tuesday:   Wednesday:

Thursday:   Friday:

(Check all that apply)

Brochure Campus Fair Counseling Services Class Presentation

Daily Sundial Faculty Flyer/Mailer Friend Website

Other: