NCHC Student Moderator Application

1. General Information

First Name

Last Name

Institution

Preferred Email (now - August 31)

Preferred Email (August 31 - November 8)

Mobile Phone

Summer Phone

School Phone

2. Honors Director Information

First Name

Last Name

Email Address

Phone Number

3. Academic Information

Major

Minor

Subject Areas of Interest

Number of honors courses completed

Number of years in the honors program/college

4. NCHC Information

Have you ever attended other NCHC Annual Conferences? (please specify)

Have you ever attended a City as Text™ session at a previous NCHC meeting? (please specify)

Have you ever attended one of the five regional association conferences that hold Business meetings at the NCHC conference? (please specify)

Have you ever attended an Honors Semester sponsored by NCHC? (please specify)

5. Availability

Title of the NCHC 2017 presentation (if applicable)

6. Special Notes