The Open Lab Team - Ekiti State University

Section 1: Contact Information

Name *

Email *

Phone *

Department/College *

Role (Student/Faculty/Staff) *

University ID Number (optional)

Section 2: Interests and Skills

Areas of interest (check all that apply)

Relevant skills or expertise

How do you envision contributing to the Open Lab?

Section 3: Membership Commitment

Membership type

Individual

Representative (organization/department)

Commitment level

Active member (regular meetings/events)

Supporter (occasional participation)

Availability for meetings/events

Preferred communication channels

Email

Slack

Social Media

In-person meetings

Section 4: Additional Information

Why are you interested in joining the Open Lab Change Agent program?

Any specific goals or projects you'd like to work on?

How did you hear about the Open Lab?

Section 5: Agreement and Signature

By signing below, I commit to:

• Uphold the values and mission of the Open Lab Change Agent program
• Respect diverse perspectives and opinions
• Maintain confidentiality when necessary
• Participate actively and contribute to program growth

I agree to the terms and conditions above *

Privacy Notice

Your information will be kept confidential and used solely for Open Lab purposes. We respect your privacy and will not share your personal information with third parties without your consent.

Open Lab Change Agent Membership

Privacy Notice