Northwestern PossePlus Retreat 2020

Friday, April 3 through Sunday, April 5 at Lake Lawn Resort in Delavan, Wisconsin.

Buses will depart from the Scott Hall Circle Drive (601 University Place) at 2:30 PM on April 3. Attendees will return at approximately 3:00 PM on April 5.

Completion of this form does NOT guarantee attendance to the Retreat. Campus Inclusion and Community staff will be in contact within four weeks of the submission deadline to let you know if we will be able to accommodate your participation at the retreat.

If you are offered a spot at the retreat, you will be asked to confirm attendance, submit a signed conduct agreement and liability waiver, and will be required to pay a refundable $25 deposit to secure your spot.

Name Name First Last
NetID
Email
Are you a Posse Scholar?

Are you a Posse Scholar? Yes No
I am a:

I am a: Graduate Student/Graduate Assistant Faculty Member Staff Member Undergraduate Student
Have you attended Posse Plus Retreat before?

Have you attended Posse Plus Retreat before? Yes No
What year(s) did you attend?
Gender Identity

Gender Identity Man Woman Trans Non-conforming / Non-binary Not listed here Not listed here
School
Graduating Year
Department
Please indicate the Posse Scholar who invited you or how you found out about this event.
Local Address Local Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Mobile Phone Number Mobile Phone Number - ### - ### ####
Emergency Contact Name Emergency Contact Name First Last
Emergency Contact Phone Number Emergency Contact Phone Number - ### - ### ####
Please select the option that best describes your roommate preference

Please select the option that best describes your roommate preference I prefer to have a roommate of the same gender I have no preference around roommate gender I prefer a quiet roommate I prefer a roommate who wants to socialize
Preferred Roommates

Please indicate up to three preferred roommates. We will try to accommodate your preference to be best of our ability.

If you have no preference, please write "N/A"
Dietary Restrictions

Including but not limited to vegetarian, vegan, gluten-free, Kosher. If you have very strict or specific dietary needs, please email BrianaNewkirk@northwestern.edu to discuss further.
Special Accommodations or Items of Note

Including but not limited to physical assistance or assistive technology, allergies, etc.
If we have reached capacity and are unable to offer you a space, are you interested in being added to the Wait List?

If we have reached capacity and are unable to offer you a space, are you interested in being added to the Wait List? Yes No
Posse Scholars - would you like CIC to invite any specific staff, faculty, or students? Leave their emails below.