Exit this survey Spring 2019 Holyoke Bound: Student Registration Question Title * 1. Contact Information: Last Name: First Name: Email: Major(s): Undergraduate or Graduate Student: Year ( Freshmen, Sophomore, Junior, Senior, 1st, 2nd, 3rd, 4th): Question Title * 2. School: UMASS Smith College Amherst College Mount Holyoke College Hampshire College Holyoke Community College Westfield State University High School (please indicate in" other" section which school you are affiliated with) Other Other (please specify) Question Title * 3. Why are you attending Holyoke Bound? Requirement for class. Requirement for my community placement. A friend, classmate, peer, staff or faculty member suggested I attend. Want to learn about the City of Holyoke. Want to learn about how to better serve with and in the City of Holyoke. Want to learn about volunteer opportunities in the City of Holyoke. Want to learn about internship opprotunities in the City of Holyoke. Other (please specify) Question Title * 4. If you are attending Holyoke Bound for a class, please write the class title, section and professor. Example: Power and Privilage in Education, SOC 285, Sam Smith Question Title * 5. Do you already have a Community Based Learning/Service Learning, Internship, Fellowship or Volunteer placement in Holyoke?If yes, please identify what type and with what organization. Example: Internship with Holyoke Boys and Girls Club. If no, please just write "No" in the below box. Question Title * 6. If you answered "yes" to question 4, what role do or will you play at your Community Based Learning/Service Learning, Internship, Fellowship or Volunteer placement . Please check all that apply. Tutor Mentor Teacher Researcher Reasearch Assistant Volunteer Coordinator Other (please specify) Question Title * 7. If you do not have a Community Based Learning/Service Learning, Internship, Fellowship or Volunteer placement yet, what type of placement are you looking for? Please check all that apply. Elementary school High school Adult education After school programs Government Social service agency/organizations Environmental organizations Public health organizations None. I am not looking to be placed anywhere at this time. Other (please specify) Question Title * 8. How many Holyoke Bounds have you attended? None, this is my first Holyoke Bound 1 2 3 4 5 Other (please specify) Question Title * 9. Transportation to and from Holyoke.Transportation to Holyoke Bound from the Five College campuses is provided. A bus will be picking up students in the morning to take them to Holyoke Bound, at Holyoke Community College. This bus will also bring students back to their respective campuses. Additional information regarding bus pick up times and locations will be posted on the Five College Holyoke Bound web page and an email will be sent out prior to the event. I am driving my own car (I do NOT need bus or van transportation) Bus from UMass Bus from Mt. Holyoke Bus from Smith Bus from Hampshire Bus from Amherst Question Title * 10. Lunch WILL be provided. Do you have any dietary restrictions? Vegetarian Vegan Lactose Intolerant Gluten-Free Other Other (please specify) Question Title * 11. If you may need any type of disability or accessibility accommodations, please let us know. Question Title * 12. How did you hear about Holyoke Bound? Flyer Email Social media Peer Faculty Amherst College Center for Community Engagement Hampshire College Partnerships for Social Change Mt. Holyoke College Community Based Learning Smith College Center for Community Collaboration Unvi. of Massachusetts Community Service Learning/Community Engagement Program Other (please specify) For more information regarding Holyoke Bound, please email mariaholyokebound@gmail.complease note: You will NOT receive a confirmation email after completing this form. A confirmation will be emailed to you prior to the event. Next