Registering as a Role Model is easy. Just fill in the fields below, and we'll get a new account set up for you in no time. Account Details Username (required) Email Address (required) Choose a Password (required) Confirm Password (required) Profile Details First Name (required) This field can be seen by: Everyone Last Name (required) This field can be seen by: Only Me Referred By This field can be seen by: Only Me Date of Birth Day ----12345678910111213141516171819202122232425262728293031 Month ----JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year ----202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950 This field can be seen by: Only Me Place of Birth This field can be seen by: Only Me Gender ----FemaleMale This field can be seen by: Only Me Education (required) ASBSMSPh. D This field can be seen by: Everyone Education Other This field can be seen by: Only Me Home Street Address This field can be seen by: Only Me Home City This field can be seen by: Everyone Home State This field can be seen by: Everyone Home Zipcode This field can be seen by: Everyone Cell Phone Number (required) This field can be seen by: Only Me Company or Organization Name (required) This field can be seen by: Everyone Company or Organization Street Address This field can be seen by: Only Me Company or Organization City This field can be seen by: Only Me Company or Organization State This field can be seen by: Only Me Company or Organization Zipcode This field can be seen by: Only Me Company or Organization Phone Number (required) This field can be seen by: Only Me Job Title This field can be seen by: Everyone Preferred Location New JerseyNew YorkMiami, FloridaGreenacres, FloridaSan Antonio, Texas This field can be seen by: Everyone Travel Preference ----Less than 5 milesMore than 5 miles and less than 15 milesMore than 15 miles and less than 25 milesBetween 25 miles and 50 milesMore than 50 miles This field can be seen by: Only Me Have you submitted your Biography? ----YesNo This field can be seen by: Only Me HISPA Interest HISPA Role Model ProgramHISPA Corporate Visit: Imagine DayHISPA Youth Conference: "Take Action! Achieve your Dreams"Host a HISPA Networking EventFunding and/or Sponsorship Opportunities This field can be seen by: Everyone HISPA Interest Other This field can be seen by: Only Me Affiliation ALPFACorporate – Employee Resource GroupsHispanic Bar AssociationProspanicaSociety of Hispanic Professional Engineers (SHPE)University - Employee Resource Groups This field can be seen by: Everyone Affiliation Other This field can be seen by: Only Me Area of Expertise Architecture, Planning & Environmental DesignArts & EntertainmentBusinessCommunicationsEducationEngineeringComputer ScienceEnvironmentGovermentHealth & MedicineInternationalLaw & Public PolicyNonprofitSciences-Biological & Physical This field can be seen by: Everyone Area of Expertise Other This field can be seen by: Everyone Change Who can see this field? Everyone Only Me All Members Close Facebook This field can be seen by: Only Me LinkedIN This field can be seen by: Only Me Twitter This field can be seen by: Only Me Security Question 8 − 3 =
