Name:
(if entering as a team*, please list a designated representative of the team here; please note that teams are limited to no more than four members)

Academic Institution Affiliation:

Year of Expected Graduation:
(must be currently enrolled)

Email Address:

Phone:

Please list additional team members, if applicable, below:

Team Member 2:

Academic Institution Affiliation:

Year of Expected Graduation:
(must be currently enrolled)

Team Member 3:

Academic Institution Affiliation:

Year of Expected Graduation:
(must be currently enrolled)

Team Member 4:

Academic Institution Affiliation:

Year of Expected Graduation:
(must be currently enrolled)

*For those entering as a team, please provide names of the rest of the team members and their academic affiliations if different from the representative's