Name: Position/Title: Address: Choose location Abington Altoona Beaver Berks Delaware County Dickinson School of Law DuBois Erie Fayette Great Valley Harrisburg Hazleton Lehigh Valley McKeesport Mont Alto New Kensington Schuylkill Shenango University Park Wilkes-Barre Worthington Scranton York Phone: - extension E-mail:
#1 committee preference:
#2 committee preference:
My special skills, talents, expertise, areas of interest (regarding this committee assignment) are:
If self nominating, please indicate how you heard about the Commission on Lesbian, Gay, Bisexual and Transgender Equity.
Following submission of this application, you will be contacted by the appropriate committee chair.
