ACM Student Leadership Summit: Student Appointment Confirmation and Registration Form (to be completed by student)

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ACM Student Leadership Summit: Student Appointment Confirmation and Registration Form (to be completed by student)

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Congratulations on your appointment to the ACM Student Leadership Summit! In addition to the in-person Summit on March 31 and April 1 in Chicago and the online Cultural Intelligence Accelerator (CQA), you will be required to participate in two virtual meetings: an initial meeting on March 8 from 8:00 – 9:00 p.m. Central and a pre-departure meeting on March 27 from 8:00 – 9:00 p.m. Central. Please complete the following form to assist ACM and Common Purpose in preparing for the Summit. Please confirm your participation in the Summit by completing and submitting this registration form no later than February 23. 
Name(Required)
We collect this information so that we can better understand the reach of this program.
We collect this information so that we can better understand the reach of this program.
We collect this information so that we can better understand the reach of this program.
Gender(Required)

We collect this information for lodging purposes.
Please provide a brief overview of your leadership experience, what you wish to gain through your participation in the Summit, and any other information that you believe would be helpful to ACM and Common Purpose in preparing for the program.
Skills & Mindsets you would like to develop(Required)
Would you like to opt into a gender-neutral lodging assignment?(Required)

A gender-neutral lodging assignment refers to a lodging option in which students mutually agree to share a multiple-occupancy bedroom without regard to the gender identity of the occupants. If you have questions or would like to discuss this option further, please contact mvertovec@acm.edu.
We aim to make this program accessible to all, including for those who have a disability or face significant challenges due to health, well-being or personal circumstances.
Emergency Contact Name(Required)

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