Bergstrom Fellows

Bergstrom Fellows Application

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

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is your email?

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* 4. What is your phone number?

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* 5. Please select your Pi Kappa Phi membership status

Associate Member

Undergraduate Member

Alumni Member

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

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* 7. What college/university do you attend?

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

Yes

No

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

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* 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?