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Metropolitan State University Registration Form

Students participating in Project SHINE should submit the Student Intake Form before the registration deadline. Information contained within this intake form is a powerful tool in the process of selecting a partner site. For more information about this intake form please contact the Mary Vang in the Center for Community-Based Learning at mary.vang@metrostate.edu.

Personal Information:

First Name: *

Last Name: *

Phone Number: *

Please do not inlcude dashes (ex: 2125555555)

Alternate Phone Number:

Please do not include dashes (ex: 2125555555)

E-mail: *

Please use your "go.metrostate.edu" address

Sex:

Male

Female

Metro State Technology ID Number: *

Current Address

Street Number and Street: *

City: *

State: *

Zip Code: *

Project SHINE Course: *

COMM 333-01 Intercultural Communications, D. Johnson

COMM 333-50 Intercultural Communications, D. Johnson

INFS 315-01: Searching for Information, M. Kantar & A. Peskorz

IDST 321 Human Rights, C. Tedder

OTHER Internship, Work Study, other

Community Partner Choices: *

Please visit http://shinetc.livejournal.com and click on "Community Partners" to choose two potential community sites.

Orientation Date: *

Orientation is mandatory and offered on Tuesday, May 22 from 1:00 - 5:00 p.m. at Metro State's St. Paul campus in LIB 302. Please specify which date you are able to attend. If you are unable to attend either orientation dates, please contact Mary Vang at mary.vang@metrostate.edu

Birth date: *

Month

Day

Year

Ethnicity/Ethnicities:

If multiple separate by comma(s).

Languages spoken other than English:

If multiple seperate by comma(s).

Highest level of education completed: *

High School Diploma

Bachelor's Degree

Master's Degree

Doctorate

Academic Major(s): *

If muliple separate by comma(s), if none specify undeclared.

Do you have experience with ESL?

Yes

If yes, explain below.

Have you participated in Project SHINE before? *

Yes

Project SHINE experience:

Please tell us when you participated in Project SHINE in the past. Name the course, instructor, college and community organization where you served.

Find Resources

National Consortium

California	Colorado
Georgia	Hawaii
Minnesota	New York
North Carolina	Pennsylvania
Texas

SHINE Stories

A Work in Progress: The American Dream

Elsuleik has big plans to go back to school here in Philadelphia to further his studies in Food & Science Technology with a Master’s Degree. Ever since he was a child, he has dreamt of becoming a professor and he hopes to fulfill that dream here in the United States.

Find more stories

Sponsored by MetLife Foundation, Corporation for National & Community Service, New York Life. The Intergenerational Center at Temple University, 1700 N. Broad St., Philadelphia, PA 19122. (215) 204-3212 phone (215) 204-3195 fax.

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