Middle School D-MEN Registration

School Name *

Coordinator Name *

On-site Coordinator Name (if different from above)

Email *

Phone *

Number of Students Attending *

Grade Levels of Students (Check all that apply) *Grade 6
Grade 7
Grade 8

Bus transportation will be provided at no cost to schools. Will your group require a bus? *Yes
No

Pick-up Location (street address)

Boarding time at school

Departure time from school

Pick-up time from DePaul

Additional Comments

If requesting a bus, please complete the following information