College of DuPage Office of Student Life Student Leadership Retreat Application Form Monday, August 1st to Tuesday, August

2nd, 2011 George Williams College, Lake Geneva, Wisconsin

Please complete this application to attend the Student Leadership Retreat. The retreat is open to all new C.O.D. students enrolled for fall 2011 and returning students (with a minimum GPA of 2.0) who have not participated in the retreat previously. Students must be available to attend the entire retreat Mon. 9 a.m. to Tues. 8 p.m. Applications are due by Thursday, July 14th to Student Life (SRC 1800) or by e-mail to studentlife@cod.edu. General Information Full Name: C.O.D. Club Affiliation (if any): E-mail: Mailing Address: Home Phone: Please mark one: Birth Date:
(for enrollment verification)

Cell Phone: Male Female

Housing and Meal Information Please list any special accommodations you may need:

Roommate Request (all attendees will have roommates):

Meals are included. Please list any special food needs or allergies you may have:

Short Application Questions: What interests you about the Student Leadership Retreat and what do you hope to gain from being a part of it?

What do you hope to gain from your experience at College of DuPage while enrolled here as a student?

By signing and submitting this form, I agree: 1. to abide by College of DuPage policies and procedures. 2. to pay up to $150 of the cost of the retreat if I do not attend after I submit this application. 3. I am a College of DuPage student and will be taking classes fall 2011.

Signature: _____________________________________________________ Date: ____________________________________