... Latino/a Student Cultural Center by mail, fax, or in person by April 1, 2012. Mail
to: Northeastern University, 120 FA, 360 Huntington Ave. Boston, MA 02115.
Become
a
Student
Leader
this
Summer!!
Please fill out the following information and return to the Latino/a Student Cultural Center by mail, fax, or in person by April 1, 2012. Mail to: Northeastern University, 120 FA, 360 Huntington Ave. Boston, MA 02115 Or Fax to: 617-373-7888 Name: _____________________________
Expected Graduation Date: ______________________________
NU ID: ____________________________
Race/Ethnicity (Optional): ______________________________
Local Address: ______________________ ___________________________________ ___________________________________ ___________________________________
Extracurricular Involvement: ____________________________ ____________________________________________________ ____________________________________________________ ____________________________________________________
Phone Number: ______________________
Major/Minor: ________________________________________
E‐mail:
______________________________________
______________________________________________________________________
Please
answer
the
following
questions,
using
250
words
or
less.
You
may
use
the
back
of
this
page
if
you
need
additional
space.
1. What
do
you
think
it
means
to
be
a
student
leader
of
color?
2. What
do
you
hope
to
gain
from
this
experience?
If
you
have
any
questions,
please
contact
Rebecca
Veira
at
617‐373‐7637
or
[email protected]
