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Coaching Program Participant Information Form
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Please complete this form as accurate and complete as possible.  If you have trouble fill out the form, please email coaching@umkc.edu.  

Clicking ‘Submit’ will forward your information the Coaching Program Staff..

First Name:   

Middle Name:   

Last Name: 

Student ID#: 

Street Address:

City:    State:   Zip:          

Cell Phone:   Home Phone:

Email Address:

Best way to contact you:  Cell Phone Home Phone Email

High School:

Graduation Year (YYYY):          

Student Type: First Year  Transfer

Previous College or University:

Number of semesters before transfer:

Degrees Held:

Intended Major:

Classification:

Do you work of plan to work during the school year?  Yes  No

If yes, where?   How many hours per week?

Briefly describe your interests in participating in the Coaching Program.  If you are a Trial Admit student, please note that in the box.

Please provide a short bio of yourself.