Memphis - The Summer Experience 2011Registration Survey

Thank you for your interest in Memphis - The Summer Experience 2011, hosted by The Leadership Academy free of charge to registered students. We are so excited that you will be sharing this summer with us! Please register for the program by answering the following questions below.

1

How did you hear about Memphis - The Summer Experience? Check all that apply.

How did you hear about Memphis - The Summer Experience? Check all that apply. Employer

College

Church

Email

Friend

Facebook

Twitter

Leadershipacademy.org

MemphisConnect.com

Returning Particpant

Other, please specify

2

Did you attend high school in Memphis? If yes, please list school.

Yes

No

Additional Comment

3

If you are not from Memphis, please list the city and state you are from?

4

During which months will you be in Memphis? Check all that apply.

During which months will you be in Memphis? Check all that apply. May

June

July

August

Other, please specify

5

Do you have an internship? If yes, please list where.

Yes

No

Additional Comment

6

If not interning, will you be working or volunteering during the summer? Please list where.

7

What college or university do you attend?

8

What degree are you currently pursuing?

What degree are you currently pursuing? Associates

Bachelors

Masters

Doctorate

Other, please specify

9

What is your anticipated year of graduation?

What is your anticipated year of graduation? 2011

2012

2013

2014

2015

Other, please specify

10

What is your major or field of study?

11

*How likely are you to begin your career in Memphis?

Very Unlikely	Unlikely	Neutral	Likely	Very Likely
*How likely are you to begin your career in Memphis? Very Unlikely	Unlikely	Neutral	Likely	Very Likely

12

*Please complete the following to confirm your registration: (Respond N/A where applicable.)

Please complete the following to confirm your registration: (Respond N/A where applicable.) Name
Age
Permanent Address
City
State
Zip
Work phone
Cell phone
Email Address
Alternate Email Address

13

What is the best way to contact you? (Please rank in order of preference.)

Email

Facebook

Twitter

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Thank you for taking the time to register for Memphis - The Summer Experience 2011. We will keep you informed of all events through Email and Facebook. Please share this opportunity with all of your friends!