Adult Lead Registration / 2024

Registration for Adult Leads identified/assigned by network partners. Adults Leads have dedicated time and passion for engaging learner cohorts through the Midwest Learner Design Summit experience, alongside a fully committed university team. 

This information will help us prepare for the Summit experience. Questions? Contact [email protected]

* denotes a required field

Adult Lead Information

Partner Organization Information

Cohort Plans for Summit Part 2

Please select your plans for engaging your cohort in Summit Part 2 (in-person). We will do our best to accommodate your selected date. *

Emergency Information


GVSU will provide reasonable accommodations to individuals with disabilities upon request. For questions about accessibility please contact [email protected].

Additional Forms

Complete, save, and upload your W-9 to receive your stipend upon successful completion of the experience.

Photographs and/or video will be taken during rep4 experiences. Your registration gives consent for any such photographs/video to be used for advertising and publicity purposes by Grand Valley State University, its licensees, and/or member organizations, and you waive all claims for any compensation for such use or for damages. Please read complete the REP4/GVSU Release Form before submitting this registration form.

In alignment with the Minors on Campus policy, an overview of electronic authorization for release of information background check will be sent to your email following registration. Your link to "Authorized Adult" training will follow in your registration confirmation email.

Gender Identity (Please select all that apply): *

Commitment Review

Human Verification *

Page last modified May 20, 2024