Complete this application to be considered for the Cal State LA HACU Student Delegate Program. The deadline to apply is August 1. Student Information First name Middle initial Last name CIN # Pronouns Which gender do you identify with? Male Female Non-binary Prefer to self-describe Prefer not to state Please select one that you best identify with: Asian American and Pacific Islander Black/Pan-African Hispanic/Latinx American Indian and Indigenous Peoples South West Asian and North African White Multiracial Prefer not to state Other... Enter other… Phone number Cal State LA email Dietary Restriction Education Information Expected graduation month/year Major Program concentration Bachelor's Master's Doctorate Other… Enter other… Class status First-year/Freshman Second-year/Sophomore Third-year/Junior Fourth-year/Senior Graduate/Doctoral Student Five or more years How did you hear about the HACU ¡Adelante! Leadership Institute? Career Center Campus email HACU alumni Professor/Staff Social media Student/Peer Website Word-of-mouth Please explain your experience or roles in leadership, including awards received. Please explain your experience with professional networking and conferences, including talking with someone about your career interests. Have you previously attended the Cal State LA HACU Student Delegate Program? Yes No If you are selected, do you agree to attend all the program events? Yes No CAPTCHA