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Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Phone Number * ### - ### - ####
Year at UM *

Keep in mind you are only eligible to be on CERT if you are a freshman, sophmore, or junior. If you select the "other" option, please explain in the field below ("time commitments").
What other time commitments do you have (extracurricular activities, sports, work, class schedule, volunteering, research, etc.)? *
Why do you want to join CERT? *
What are your strengths and weaknesses? How do you think these will enhance/detract from your participation in CERT? *
Do you speak any foreign languages? If so, which one(s)? If your only language is English, please type "None."
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