NSBE-WBESS Membership Application
First Name:* Last Name:*
Address Line 1:* Address Line 2:
Apt #: City: State: Phone:1* Zip:*
Email id:* @wisc.edu Major: Biomedical Engineering Chemical and Biological Engineering Civil and Environmental Engineering Electrical and Computer Engineering Engineering Physics Nuclear Engineering Engineering Professional Development Industrial and Systems Engineering Materials Science and Engineering Mechanical Engineering College of Agricultural and Life Sciences School of Business School of Education School of Human Ecology College of Letters and Science School of Medicine and Public Health School of Nursing School of Pharmacy
If you chose another college outside of engineering, please specify:
Classification: High School Freshman Sophomore Junior 4th Year Senior 5th Year Senior Graduate Student Faculty Graduation Date: December 2007 May 2008 August 2008 December 2008 May 2009 August 2009 December 2009 May 2010 August 2010 December 2010 May 2011 August 2011 December 2011 Gender: M F
Date of Birth: Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year: 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950
Resume:2 How do I create a resume?
Please fill out the questions below
Are you interested in** Summer Internship Fall Co-op Spring Co-op Graduate School Full Time
How did you hear about NSBE? Friend Flyer E-mail Other
If other, please specify:
Would you like to add any exams to our database? N Y If yes, how many?
Interested in being in a mentor program? N Y
How many years have you been in NSBE? Have you previously held a board position? N Y
What commitees will you be interested in joining?** Christmas 4 kids Christmas Party at the YWCA Banquet Fundraising Outreach Pre-College Initiative (PCI) Social Publications Day on Campus Conference Planning Programs Academic Excellence
Current Semester Schedule (i.e. PHYSICS 112, MATH 103, ECE 553, etc. as listed in the timetable)
Course Name: Course Number:
What type of things would you like to see NSBE-WBESS do this school year?
* - required field ** - hold down the ctrl key to select more than one choice 1 - enter phone number in the format 1234567890 with no parentheses or dashes. 2 - make sure the resume is in MS Word document