What is your name?
What is your phone number?
What is your firstname.lastname@example.org email address?
What campus or cohort location are you from?
Please provide the reason why you cannot attend Mardi Gras.
What is the name of the person who can verify your extenuating circumstance?
What is the phone number of the person who can verify your extenuating circumstance?
What is the email address of the individual who can verify your extenuating circumstance?
Please provide documentation to support your request to not attend Mardi Gras.
Please check the box to confirm that you understand the requirements.
By typing in your name in this field, you are certifying that this is your official signature.