Student or Team Representative Name:

University/College:

University City and State:

Major:

E-mail:

Phone Number (optional):

Academic Field of Interest (Select One from only One of these Categories):

BEHAVIORAL & MEDICAL SCIENCES:
Pick One: - Audiology and Speech Pathology - Criminal Justice and Criminology - Health and Medical Technology - Dieteics, Food & Nutrition - Medical Prepatory Programs - Nursing - Parks, Recreation & Fitness - Physical Therapy - Psychology - Social Work

BUSINESS & ADMINISTRATION:
Pick One: - Accounting - Applied Mathmatics - Economics - Financial Management - General Business - General Mathmatics - Marketing - Public Administration

EDUCATION:
Pick One: - Elementary Education - Mathematics & Science Education - Physical Education - Secondary Education - Special Education

ENGINEERING:
Pick One: - Aerospace, Aeronautical & Astronautical - Architecture & Environmental Design - Chemical Engineering - Civil Engineering - Computer Systems Engineering - Electrical Engineering - Industrial Engineering - Mechanical Engineering

HUMANITIES & SOCIAL SCIENCES:
Pick One: - Anthropology & Archaeology - Communications - Dramatic Arts - English Language & Literature - Foreign Languages & Literature - Geography - History - Journalism - Legal Studies & Pre-Law - Liberal Arts & General Studies - Music & Dance - Philosophy - Political Science & Government - Sociology - Visual Arts, Graphics & Design

NATURAL SCIENCES:
Pick One: - Animal Food Sciences - Biology & Life Sciences - Chemistry - Forestry & Environmental Sciences - Geology & Geophysics - Geology & Biochemistry - Physics & Astronomy - Plant Food Sciences

TECHNOLOGY:
Pick One: - Computer Science - Data and Information Processing - Electrical Engineering Technology - Industrial Production Technology - Mechanical Engineering Technology - Software Development - Web Development

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Special Skills, Knowledge and/or Description of Team: