First Name*

Last Name*

Email*

Phone Number*

What gender do you best identify as?*

Female

Male

Other

Prefer not to say

What is your date of birth?*

Month/Day/Year

How would you describe yourself?*

Are you actively involved with any clubs or organizations on campus? If yes, please share their names and your role(s).*

How did you find out about 'The Collective' Program?*

Congo Clothing Company's website

My University

Friend

Social media

Other

What University are you enrolled in?*

What City is your University located in?*

What State is your University located in?*

What is your current year?*

Freshman

Sophomore

Junior

Senior

What is your Linkedin URL?*

Is there anything else we should know?

Submit