Fairmont State Counts Registration Form

Donna Yergovich Nuzum
Director Center for Civic Engagement
Room 317 Education Building
Phone: (304) 367-4830
Donna.Nuzum@fairmontstate.edu

Cathy Woodson
Administrative Assistant, Center for Civic Engagement Office
Room 317 Education Building
Phone: (304) 367-4579
Catherine.Woodson@fairmontstate.edu

Kristin Yoho
FSU Reads Graduate Assistant
Room 317 Education Building
Phone: (304) 367-4204
kyoho3@students.fairmontstate.edu

Amanda Krepps
Student Office Assistant
Room 317 Education Building
afloyd@students.fairmontstate.edu

Spring 2011

Please note that Fairmont State Counts starts Tuesday, Feb. 15th, and goes through Thursday, April 14th, 2011.

I would like my child to participate: *

Parent/Guardian Name: *

E-mail Address: *

Child's Name: *

Grade: *

Age: *

School Name: *

Address: *

City: *

Zipcode: *

Home Phone: *

Cell Phone: *

Emergency Phone: *

Do you have an objection to your child be photographed or video taped: *

Allergies and/or other important information the director should know about the student:

Appropriate behavior is expected. Students not complying, will lose Fairmont State Counts privileges.

If classes are cancelled at Fairmont State's main campus, Fairmont State Counts will also be cancelled

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