Chicana/o Latina/o Graduate Recognition Application

Please fill out completely! All spaces must be filled out to be submitted!

Student Information:
Full Name: (as will appear on program)
Please Choose:
# of Extra Tickets at Dinner: (if available)
# of Extra Tickets at Presentation:
Handicapped Request:
Stole Left:	Class of 2008
Stole Right:
Email:
Street Address:
City, State, Zip:
Home Phone:
Cell Phone:
Major(s):
Minor(s):
Keynote Speaker Nominee:
National Flag (will be represented at Presentation):
Entertainment Suggestion:
I am interested in:
Would you like the opportunity to have 1 or 2 family members on stage with you during your thank you? :
Message (200 words or less) to be included in program:
Community Involvement:
School Activities:
Future Plans:
Parent Information
Name:
Name:
Address:
City, State, Zip:
Phone:
Language:
	I have read and understand the Graduate Participation Guidelines.

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