Culture Club Application

Personal Information

1. I am a: Please select one International student International visiting scholar International spouse Community member
2. Full Name:
3. Gender: Please select one Male Female Other
4. Date of Birth: (MM/DD/YYYY)
5. Country of Citizenship:
6. Country of Birth:
7. Email Address:
8. Local Street Address:
   
9. Local City:
10. Local Zip Code:
11. Campus Box Number:
12. Home Phone Number:
13. Work Phone Number:
14. Your status (in relation to Duke): Please select one Undergraduate Graduate student Visiting scholar International spouse Community member
    If you're an undergraduate, year and major:
    If you're a graduate student, department or school:
    If you're a visiting scholar, department or school:
    If you're a community member, occupation:
15. Can you provide your own transportation: Please select one Yes No

Application Information

16. Which languages do you speak?
    
17. Please list the countries that you have lived or studied in and the dates you lived there:
    
18. Please describe any other cross-cultural experiences:
19. Do you have previous presentation or teaching experience? Please select one Yes No
    If yes, please tell us a little about that experience:
    
20. Why are you interested in becoming a Culture Club presenter?