COACH/TEACHER APPLICATION FORM  

Summer Debate Institute
202 Haag Hall
5100 Rockhill Road
Kansas City, MO 64110
816.235.1667
816.235.5519 (fax)
collierl@umkc.edu

SUBMIT FORMS BY June 15 With Non Refundable$50 Deposit

Mark all those appropriate

___ Topic Analysis Week (July 8-12) ___Administration & Teaching Week (July 15-19)

___Paper Evidence ___Electronic evidence (CD) ___I will enroll for graduate credit

 

Personal Information: (Please type or print)

Name:_______________________________________________________________________________
          Last First Middle

T-shirt size ____________________
             Title L XL XXL

Address:____________________________________________________________________________________
            Number Street Apt.# City State Zip Code

Sex: ____F ____M

Social Security Number_____ - _______ - _______

Birthdate _____/_____/_____
            MM DD YY

Telephone Number(s): Home_________-_________________

Office _________ - ___________________
         Area Code Number

Other Phones: ________ - ________________

E-Mail Address ______________________________________

School Information:

School Name:_______________________________________________________________________________

School Address:_____________________________________________________________________________
            Number Street City State Zip Code

You will receive appropriate schedules and enrollment information within 10 days of your application.

 

Mail to:

UMKC Summer Debate Institute
202 Haag Hall
5100 Rockhill Road
Kansas City, MO 64110-2499