The University of Texas at Dallas

Page 1 of 2 -- CONTACT INFORMATION

Sign me up for the following STEM Information Session: *	Saturday, Feb. 16, 2008	Required
Number of people in your party:	01 02 03 04 05 (Including Student) Each High School junior or senior must register separately.
First Name:*		Required
Middle Inital:
Last Name:*		Required
Address I:
Address II:
City:
State: *	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachuset Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virgin Wisconsin Wyoming	Required
Zip:
Gender:	Male Female
Ethnicity:	Asian/Pacific Islander Black American Hispanic International Native American White
Birth Date (mm/dd/yyyy):	/ /
Email Address:*		Required
Phone # (No dashes):*		Required.

For additional information contact:

Teresa Lynd, Assoc. Director of Erik Jonsson School of Engineering & Computer Science. Send an email to tclynd@utdallas.edu, or call 972-883-6548.