RooGate

Your gateway to service-learning opportunities

Enroll With Us - Participant

The following information will be used by UMKC's Service-Learning Program to best determine your placement for service and to keep you informed of service opportunities or events. (Non-identifying information may also be used for program development and assessment purposes.) Kindly fill in the form as completely as possible.
General Information
All Required (*)
Student ID/Empl ID *
Last Name *First Name *Middle Initial
UMKC / Local Address
Box No. / Street Phone
* *
City State Zip
* * *
Permanent Address
Box No. / Street Phone
City State Zip
Email Address *
Participant Background Information
Participant Status Required
Your academic major / department
Check here if undecided.
Anticipated Year of Graduation Required if student
20142015201620172018201920202021202220232024
Gender
Male Female Prefer not to respond
What category best describes your racial or ethnic origin? (optional)
 African American (non-Hispanic) Hispanic/Latino/a Asian/Pacific Islander
 Multi-racial European American Native American / Alaskan Native
 Prefer not to respond
How did you hear about UMKC's Service-Learning Program?
 Instructor/advisor Flier/Poster/Advertisement Classmate
 Alumni Parent/alumni Email
 Student Organization member Website Other
Are you able to drive Are you able to drive yourself or others to your service locations?
Please note: UMKC Service-Learning is not able to provide transportation to the service site. This information is collected for the purpose of assisting with carpooling.
Yes No
Your Service Interests, Preferences and Skills
I am interested in working in the following service areas (Check all that apply using CTRL and SHIFT keys).
Do you Accept the Terms of the UMKC RELEASE AND HOLD HARMLESS AGREEMENT?
Yes
 
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