Faculty/Staff Facilitator Sign-Up Form

basic information     First Name Last Name Peoplesoft/EMPL ID

local address     Campus Address Campus Phone Other Phone (ie. cell)

preferred e-mail

facilitator history     Are you a current UConn Connects facilitator? Yes No How many students would you be willing to take? Select 1 2 3 4 or more I'm an HDFS 288 student.

additional comments   Please let us know of any special requests, questions, or comments.