Western Illinois University: Macomb Campus

Name: *

WIU ID#: * - -

Phone: * (XXX-XXX-XXXX)

Email: *

Hometown:

Year in school: * Freshmen Sophomore Junior Senior Graduate Student

Major(s)/Minor(s): *

Besides classes, what else are you currently involved with here at WIU:

Why are you interested in WIIT: *

The WIIT workshop will take place on Friday, September 28, 2012 from 2:00-7:00 p.m. and Saturday, September 29, 2012 from 9:00 a.m.-6:00 p.m. Attendance is mandatory on both of these days. It will be the first time we all get to work together and when we begin developing the skits to be performed. If you are unable to attend the two-day workshop please tell us and indicate why:

If you choose to be a part of this exciting new organization on campus, know that you will be among a very select group of students dedicated to promoting awareness about issues of domestic and dating violence, sexual assault and stalking. We are asking for your commitment through May 2013 and you can expect to perform 2 to 5 scenes in that time frame.