2019 SYMPOSIUM ON STUDENT SCHOLARSHIP April 9, 2019 Student Submission Form Deadline: 5:00 p.m. on February 25, 2019 NAME OF STUDENT(S) (as they should appear in the program) STUDENT CONTACT INFORMATION (for groups, choose a single point of contact) Campus Box: Phone: E-mail address: NAME OF FACULTY MENTOR FACULTY MENTOR CONTACT INFORMATION Department: Office Phone: E-mail address: TYPE OF PRESENTATION Paper Presentation Pecha Kutcha Poster Performance (Music/Dance) EQUIPTMENT NEEDED Computer Projection System Piano Other: ASSESSIBILITY SERVICES NEEDED Sign Language interpreter Accessibility Accommodations Other: PRESENTATION SUPPORT SOURCE: Kirbo Scholars Program Richard Scholars Program George Scholars Fund Synovus Program Other:
2019 SYMPOSIUM ON STUDENT SCHOLARSHIP April 9, 2019 Student Submission Form Deadline: 5:00 p.m. on February 25, 2019 NAME OF STUDENT(S) (as they should appear in the program) STUDENT CONTACT INFORMATION (for groups, choose a single point of contact) Campus Box: Phone: E-mail address: NAME OF FACULTY MENTOR FACULTY MENTOR CONTACT INFORMATION Department: Office Phone: E-mail address: TYPE OF PRESENTATION Paper Presentation Pecha Kutcha Poster Performance (Music/Dance) EQUIPTMENT NEEDED Computer Projection System Piano Other: ASSESSIBILITY SERVICES NEEDED Sign Language interpreter Accessibility Accommodations Other: PRESENTATION SUPPORT SOURCE: Kirbo Scholars Program Richard Scholars Program George Scholars Fund Synovus Program Other:
Sympsoium%20Application.docx