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STAR Individual Program Registration
Submitter's First Name:
*
Submitter's Last Name:
*
Submitter's Position:
*
Submitter's Email Address:
*
Chapter:
*
Alpha Chi Omega
Alpha Epsilon Phi
Alpha Phi
Kappa Alpha Theta
Pi Beta Phi
Sigma Kappa
Date of Program:
*
+
Expected Attendance:
*
Risk Category:
*
Bystander Intervention
Sexual Assault
Mental Health
Substance Abuse
Policy Awareness
Other
Please describe "other":
*
Program Type:
*
MIT Office
External Group
Chapter Member
National
Program Presenter:
*
Presenter Role:
*
Sister
Exec Member
MIT Staff
National Representative
External Volunteer
GRA
Other
Please describe "other":
*
Program Description:
*
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