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CIDD Summer Program

Personal Information*

Please make sure provide your full name, birthday and gender. We need to know your birthday to issue you a Coastal Carolina ID.

Name (Given and Family. Example: Michael Stein)
Birthday: (Day/Month/Year)
Female or Male

Contact Information*

We will use your e-mail to send you more information about the program. If you have a mobile phone that works in the U.S., please provide us with that number.

Emergency Contact (name, e-mail and phone)

Educational Background*

The contact person at your university should be able to verify your proficiency in English. Please include his/her name and e-mail.

Home University
Field of Study & Semester
Contact Person at University (Name + E-mail)

Additional Information (optional)

Under Passport, please provide the country of your passport and the passport number. If you have a E.U. passport you do NOT need a visa for the U.S. Please make sure that your passport is valid for at least 6 months after the date you enter the U.S.

What kind(s) of company would you like to do a consulting report for?
Passport (Country, Number & Date). If not available write NA.
T-shirt size (small, medium, large or XL in U.S. sizes)

Medical Conditions & Dietary Restrictions (optional)

Please describe any medical conditions, allergies or dietary restrictions that we should be aware of. We will keep this information private.