New Participant Application

All participants must complete this one-time application before registering into a course.

**This application does not need to be completed again after the initial submission.**

SAGE Scholars MUST Review:
Community Standards & Shared Responsibilities

**All SAGE Scholars participants will be eligible for a university parking permit free of charge. Please be sure to complete the vehicle information in your registration if you would like to receive one.**

Additional questions, please contact Scott King (sking4@su.edu)

Full Legal Name (F, M, L): *

Maiden Name (enter N/A if none): *

Birthdate (MM/DD/YYYY): *

Last Four of SSN: *

Street Address: *

City, State, Zip: *

Email: *

Cell Number: *

Have you ever been convicted of a felony?

Yes

Vehicle MAKE (enter N/A if not applicable): *

Vehicle MODEL (enter N/A if not applicable): *

Vehicle LICENSE PLATE (enter N/A if not applicable): *

What do you hope to gain from participating in this program? (100 words max):

What would you like your instructor to know about you before beginning the course? (100 words max - will be shared with instructor):

I have read and agree to abide by the Shenandoah University Community Standards & Shared Responsibilities document.

* Required Field

New Participant Application

More Details

SAGE Scholars