City of Hampton, Unity Commission, Diversity College Registration

Diversity College Application

All fields marked with * are required.

Diversity College Registration
*Class:
*Name:
Nickname:
*Address:
City:	State: Zip:
*Daytime Phone:
*E-mail:
The following information is confidential and is requested only for the purpose of insuring that the class sessions are diverse.
*Job Title:	Department:
*Age:	Gender: Religion:
*Educational level achieved:
Indicate why you are interested in enrolling in the Hampton Diversity College:
What do you hope to gain or learn from participating in the Hampton Diversity College?:
Describe your involvement with other community and/or civic activities:
How did you hear about the Hampton Diversity College?:
Additional Comments: