Please fill out the information below.

All fields marked with ** are required.

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Personal Information
E-Mail Address: **
Phone Number (cell): **
First Name: **
Last Name: **
Preferred name for name tag:
College or University: **
City/State: **
    
Year In School: **
Graduation Year: **
Major: **
GPA:
Staying at the Hilton Boston Logan? **
Need an accessible room? **
Need a roll-in shower? **
Please list any other accommodations you may need
 
Will a Personal Care Assistant be accompanying you?
   Name:  **
 
Programmatic Accommodations
 Sign Language Interpreter  

Amplification System?


Real-time captioning is provided for everyone.

Braile materials?


Large Print?


E-text or CD?
 
Please list any dietary requirements or food allergies
  
 
Essay Question - In 250 words or less, please describe what you would like to gain from attending the COSD FULL ACCESS Student Summit and how you anticipate using this experience to advance your career development.
 
To attend the FullAccess Summit, you are required to submit your resume.
Submit your resume as an attached Word doc to maustin3@COSDonline.org.
COSD will confirm receipt of your resume by return email.
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