Student Volunteer Application Form


Student Name:
_______________________________________________

Street Address 1:
_______________________________________________
Street Address 2: _______________________________________________
City: _______________________________________________
State, Postal Code: _______________________________________________
Country: _______________________________________________
Telephone: _______________________________________________

Fax:
_______________________________________________

Email:
_______________________________________________

Citizenship:
_______________________________________________

Passport Number
(non-US citizens only):
_______________________________________________

Visa Number
(non-US citizens only):
_______________________________________________

I need to obtain a visa to
enter the United States:
YES    NO

Name of your University:
_______________________________________________

Name of your Degree Program:
_______________________________________________

Name of your Department:
_______________________________________________

Your Status in the Program
(Jr., Sr., Masters, Ph.D.):
_______________________________________________

University Address 1:
_______________________________________________
University Address 2: _______________________________________________
City: _______________________________________________
State, Postal Code: _______________________________________________
Country: _______________________________________________

Name of Faculty Member who
is recommending you:
_______________________________________________
Faculty Telephone: _______________________________________________

Faculty Fax:
_______________________________________________
Faculty Email: _______________________________________________
Faculty Web-site: _______________________________________________

Signature: __________________________________________      Date: _________________


IMPORTANT

In order for your application to be considered, the above faculty member must send an email to Dr. Raffo at verifying your status in the program and your ability to act as a volunteer. Strong English language skills are important, as well as the student's reliability in fulfilling commitments and potential career benefit from attending the ICSE conference. The faculty member should comment upon these abilities.

If you are accepted as a volunteer, you will be expected to provide approximately 20 hours of volunteer work during the week of May 2 - May 10, 2003. Please fill out the schedule form with your preferred times to work and fax that to Dr. Raffo.

ICSE will provide you with a free conference registration. This includes attendance to the technical program, one free tutorial or workshop, meals, break time refreshments, a banquet ticket, a conference proceedings and a T-Shirt. You will be responsible for your own accommodations. Please be sure to complete the accomodation form, also. Fax all forms to Dr. Raffo at +001-503-725-5850.