The Diversity Center

Name:

Preferred Name on Nametag:

PLU Email:

Student ID:

Year in school:
1st Year
2nd Year
3rd Year
4th Year
4+ Years/Other
Graduate School

How did you hear about the Queer Student Retreat?:
Please check all that apply!
Flyer
Email
Friend or referral
PLU online events calendar
dCenter Website
Crossroads or Harmony
Resident Director
Faculty
Administrator/staff
Other:

How do you identify?:



Please present your reason for wanting to attend the Queer Student Retreat. (please limit responses to 1-2 paragraphs)

Retreat Logistical Questions

Please list any special accomodations or dietary considerations that you have for the retreat:



Additional information you want us to know: