Bergstrom Fellows Application

Thank you for your interest in becoming a Bergstrom Fellow. Please complete the requested information below to start the process.

* 1. What is your first name?

* 2. What is your last name?

* 3. What is your email?

* 4. What is your phone number?

* 5. Please select your Pi Kappa Phi membership status

* 6. What chapter of Pi Kappa Phi are you a member of?

* 7. What college/university do you attend?

* 8. Do you currently work for a camp that serves people with disabilities?

* 9. If so, what is the name of the camp?

* 10. If you do not currently work for a camp that serves people with disabilities. What are the possible camps that you are interested in working at?

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