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Contact Information for Lead Student
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Last Name |
First Name |
M.I. |
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Date |
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Street Address |
Apartment/Unit # |
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City |
State |
ZIP Code |
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Phone Email
Additional Students on Team
1. _______________________________ _____________________________ ______________________
Name Email Cell Phone
2. _______________________________ _____________________________ ______________________
Name Email Cell Phone
3. _______________________________ _____________________________ ______________________
Name Email Cell Phone
4. _______________________________ _____________________________ _____________________
Name Email Cell Phone
In which of the following Competition Focus Areas are you applying? (Check up to three)
___ Change Management ___ Human Resources ___ Finance ___ Information Technology
___Marketing/Branding ___ Leadership ____ Nonprofit Management ____ Public Sector Management
College/University Affiliation of Lead Student
University: _______________________________________ Major: __________________________________
Club Affiliation(s): __________________________________ Expected Date of Graduation: _______________
Month/Year
Program Level: |
Undergraduate ☐ |
Masters ☐ |
PhD ☐ |
Client Contact Information
____________________________ _____________ _________________
Name Title Telephone
____________________ _____________________ ___________________
Name of Company Address #1 Address #2
____________________________ _________________________________
Email City/State/Zip
Description of Client’s Problem/Opportunity (500 words or less)
This description will help us to assign the right CMC Mentor to your project.
To submit this Intention to Apply, please contact Liz Kemker at ekemker@willamette.edu