TBD -- UCA Downtown

Contact Information

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* 1. Business Name

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* 2. Contact Person

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* 3. Email

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* 4. Phone

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* 5. Approximately how many employees will be participating in the challenge?

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* 6. Please choose the month(s) in which you are interested in having your team participate in the challenge:

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* 7. Please choose the preferable day(s) of the week for your team to participate in the challenge:

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* 8. How did you first hear about the team building challenge?

Someone from UCA Outreach & Community Engagement will be contacting you soon concerning your submitted form. Please call Dr. Shaneil Ealy at 501-450-5275 or email sealy@uca.edu if you have any questions.
UCA would like to collect demographic information to help us better serve our customers and event participants. These questions are voluntary and any information you provide will remain confidential and will only be used in aggregate form.

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* 9. What is your gender?

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* 10. Please select the category that includes your age:

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* 11. Which of the following best describes you?

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* 12. What is the highest level of education that you have completed?

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