LDI Student Information Form - Indiana WEA

Please fill out the LDI Student Information by August 16th.

Name(Required)

First Last

Email(Required)

Company(Required)

Job Title(Required)

Professional Bio (please ensure it is in paragraph form)(Required)

Please include, in 200 words or less, a bio describing your current work, your educational background, and your general industry experience. Please write your bio in the third person in a manner suitable to be presented in a student profile packet for course instructors and classmates.

Will you attend the LDI Meet and Greet on 8/21 from 1:00-2:00 PM?(Required)

We strongly encourage you to join us for the LDI Meet & Greet at the IWEA Annual Conference. It will be an opportunity for you to meet the other students. Stick around for a full day of sessions! LDI students receive complimentary admission to the conference on Thursday.

Yes

Will your mentor be attending the LDI Meet and Greet on 8/21 from 1:00-2:00 PM?(Required)

We want to meet your endorser/sponsor! Please consider encouraging your mentor to attend the LDI Meet and Greet for information on what to expect over your 12-month journey.

Yes

Have you already registered for the IWEA Annual Conference?(Required)

Yes

Headshot

Max. file size: 50 MB.

Institute Fee(Required)

Price:

*Please note, if you have selected 'invoice' for your application fee, we will charge you with one invoice.

Total

Payment Type(Required)

Credit Card

PO Number

Invoice

Contact Email for Invoice

Please put PO Number Here

If you do not have your PO number, please register once you do.

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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