Health & Science Preview Day

Student Contact Information

Student First Name

Student Last Name

Student Preferred Name (the name you prefer to be called - do not include your last name)

Student Email Address

Confirm Student Email Address

Student Birthdate

Student Mailing Address

Country

Street

City

Region

Postal Code

Student Cell Phone

Our admissions team regularly uses text messaging to communicate important application and enrollment information. May we use this form of communication to update you through the process?

Yes

By selecting "yes", you consent to receive notifications from this organization. Reply STOP to unsubscribe. Msg & Data rates may apply.

Parent / Legal Guardian Contact

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Cell Phone

Relationship to Student

Academic Information

What semester do you plan to begin college?

Student Type

Current or Most Recently Attended School

Campus Visit Details

Each student will have the opportunity to participate in two breakout sessions. Please select your top three options below.

1st Choice:

2nd Choice:

3rd Choice

Each student will have the opportunity to participate in two breakout sessions. Please select your top three options below.

1st Choice

Biology

Nursing

Pharmacy

2nd Choice

Biology

Nursing

Pharmacy

What academic area would you like to visit with during the department visit?

Which of the following secondary education teacher-licensure options are you interested in?

Number of guests coming with you.

Do you or anyone in your party have accessibility needs?

Yes

Please describe the accessibility needs:

Other Requests/Comments