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Intercultural Welcome 2009 - RSVP Form

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First Name Preferred Name/Nickname: Last Name: E-mail Address:  Enter a valid email address. Example: name@company.com Mobile Phone Number:  Enter a valid phone number. Example: 123-456-7890 Campus Residence (Building/Room #): Gender: Male Female Sexual Orientation: Lesbian Gay Bisexual Straight Other Number of Guests: With which of the following ethnicities do you further identity? Please select all that apply.: Black/African American African American Black Caribbean Other: Latino/a - Hispanic American Caribbean Central American Cuban Dominican Mexican Puerto Rican South American Spanish White Other Middle Eastern American Arab Egyptian Iranian Iraqi Israeli Lebanese Palestinian Persian Saudi Arabian Syrian Turkish Other Indigenous/Native American Alaskan American Hawaiian Tribal/American Indian Other White American Australian Canadian Caribbean Central American Eastern European Western European Scandinavian South American Multiple ethnicities/heritages Other Asian Chinese Taiwanese Asian Indian Japanese Pakistani Korean Filipino Vietnamese Hmong Thai Cambodian Laotian Bangladeshi Indonesian Sri Lankan Singaporean Malaysian Other Pacific Islander Native Hawaiian Guamanian/Chamorro Samoan Tongan Fijian Other Decline to Stay If Multiracial (please specify) Are you registered to vote? Yes No Are you be interested in any of the following activities (select all that apply): Social Dialogue Sessions Leadership Development Cultural Programs Academic Sessions/Resources Gender/Sexual Orientation events Other Click here to edit text. Would you be joining any cultural clubs and organizations this year? Yes No EIS Peer Mentor Program helps first year/transfer students navigate your transition on campus. As a first year/transfer student you will be assigned a Peer Mentor. Do you have any concerns or questions that you would like the Peer Mentors to address at the welcome? Note: This is totally confidential.

Note: If you run into any problems registering online, please contact Mrs. Cindy CMlemore@lmu.edu or 310-338-5808. 

Disclaimer: All responses to this survey will be kept confidential. Your name or identity will not be linked in any way.