2019 MIP Registration

Registration for April 24 is full. Would you like to be placed on a waitlist? If Yes, please complete the entire form.Yes
No

School Name *

Coordinator Name *

Phone Number *

Email Address *

Number of students you plan to bring (max 25) *

Grade level(s) of students *Grade 9
Grade 10
Grade 11
Grade 12

Will your school stay for the afternoon activity from 2:30pm-3:30pm? *Yes
No

DePaul Campus Tour - Open Mic - D-MEN Challenge

Does your school currently have a male mentoring program? If yes, please describe

Additional comments

I understand that all students attending the MIP conference must provide a signed photo release form *Yes