OSUIT Leadership Foundry Application

Personal Information

First Name

Last Name

Social Security Number (SSN)

Mailing Address

Country

Street

City

Region

Postal Code

Email Address

Biographical Information

Sex

Date of Birth

Colleges and universities are asked by many groups, including the federal government, accrediting associations, college guides, and newspapers, to describe the ethnic/racial backgrounds of their students and employees. In order to respond to these requests, we ask you to answer the following two questions.

This information is collected to comply with the Title VI of the Civil Rights Act of 1964 and Title IX of the Education Act of 1972 to be used for reporting purposes and does not determine admission to OSUIT/OSU-OKC.

View Definitions

Are you Hispanic or Latino?

Regardless of ethnicity, select from the following groups in which you consider yourself to be a member:

Derived From:

Tribal Affiliation

Residency Status

Are you a resident of Oklahoma?

How long have you lived in Oklahoma?

Company Information

Company Name

Is your company paying for your participation in the Leadership Foundry?

I will be paying personally

My employer will be paying

Please contact my employer about paying for this program

Please note: The total cost of the Leadership Foundry program is $2,500.

Please note: The total cost of the Leadership Foundry program is $2,500. We offer a 10% discount for businesses who enroll multiple students.

Company Contact First Name

Company Contact Last Name

Company Contact Phone

Company Address

Country

Street

City

Region

Postal Code

Certification

I understand that my records are protected under a number of federal and state confidentiality regulations and cannot be disclosed without my prior written consent unless otherwise provided for in state and federal regulations, such as directory information. I also understand that I may revoke this consent by writing a request at any time except to the extent that action has been taken in reliance on it (e.g. information has been sent or received prior to your revocation, etc.).

Acknowledging the above, with the attached signature, I hereby give authority to proceed as directed herein.

Signature

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