Experiential Panel Application

Please print out this form, fill out and bring it to class, or copy it into an email and send it to Stacy at keogh@unm.edu.

Name:                   

Email:

Phone #s:

Age:                

How do you identify yourself ethnically or culturally?:

Occupation:              

Parents' Occupations:

Relationship Status ("Sig. Other?"):

Are you a parent?

Other information relevant to panels:

THREE panel choices, in order of preference:

1.

2.

3.

Panel topics and approx. dates:
A) Gender & Socialization (Sept 13)
B) Housework & Parenting (Oct 11)
C) Gender in the Workplace (Oct 25)
D) Gender, Religion & Spirituality (Nov 27)