DiscoverCTL Program

To apply for participation in the PCC DiscoverCTL complete this form and submit

Please provide the following information:

* Indicates required information.
Name:*
Address:*
City:*
State/Province:*
Zip/Postal Code:*
Phone:*
Email:*
Position:
Department:
Office#:
Courses Taught:

Tell us why you would like to participate in the DiscoverCTL program. You can be as brief or as verbose as you would like. You could write one or two sentences, three or four pages or something in between.

Thank you very much for completing this form.

To submit your information click the "Submit" button below. After you press the Submit button, BE SURE that you print the next page that you see and also save a copy as a text file.

For more information please contact:

Ms. Connie Black-Postl

Partners in Context and Community

209E Harshman Hall

Bowling Green State University

Bowling Green, OH 43403

(419) 372-9443

Fax: (419) 372-9779

Email: pcclc@listproc.bgsu.edu

Partners in Context & Community
http://www.bgsu.edu/colleges/as/pcc
Bowling Green State University, Bowling Green, OH 43403
Copyright © 2001. Bowling Green State University.
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