PLCer Contact Information

Name (Last, First) *

Preferred First Name (Nickname) *

Please indicate what you prefer as your first name - this is for face-to-face purposes and your formal PLC namebadge (example: Teddy instead of Theodore)

Your Pronouns *

Please indicate the pronouns you use so we can best learn how you identify

Intended Major *

Please enter your intended major at CU Boulder. If it has changed since your application, we want to know your NEW choice!

Email Address *

Please enter the email address you are most likely to check this summer.

Cell Phone Number *

Birthday *

Dietary Restrictions/Food Allergies *

Please list your required food restrictions or allergies (not just preferences). If these are life threatening, please indicate so. If you have none, please just enter "N/A."

Dorm Name or Living Location *

Please let us know the dorm you will be living in this academic year if you know your assignment. If you do not yet know, please enter 'Not yet assigned.'

Mother/Guardian Name and email

Please enter the name and email of your mother/guardian. If this person is not in your life, please enter "N/A."

Father/Guardian Name and email

Please enter the name and email of your father/guardian. If this person is not in your life, please enter "N/A."

Digital Photo/Head Shot *

Please upload a photo of yourself for the PLC scholar board. This can be a head-shot, senior photo, or another photo you prefer. Please no family or group or party photos.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png.

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PLCer Contact Information