Person Scheduling Visit

Person Scheduling the Visit

Other

Scheduler's First Name

Scheduler's Last Name

Scheduler's Email Address

Scheduler's Phone Number

Student Information

Type of Student

First Name

Preferred Name
If the same as the student's first name, please reenter the first name

Last Name

Email Address

Birthdate

Phone Number

Type of Phone

Evening Phone

Mobile Phone

Primary Phone

Permission to Text

Yes

No

Mailing Address

Country

Street

City

Region

Postal Code

Academic Information

Anticipated Start Date

Academic Area of Interest

High School Information

Is the student homeschooled?

Yes

No

Graduation Year

High School Name

College or University Information

Graduation Year

College or University Name

Would you like to add another college or university?

Yes

No

Graduation Year

College or University Name

Would you like to add another college or university?

Yes

No

Graduation Year

College or University Name

Visit Information

Please list any accessibility requirements

Guest Information

Number of Visitors
Not including the student

Guest 1 First Name

Guest 1 Last Name

Guest 1 Email Address

Relationship to Student

Guest 2 First Name

Guest 2 Last Name

Guest 2 Email Address

Relationship to Student

Guest 3 First Name

Guest 3 Last Name

Guest 3 Email Address

Relationship to Student

Guest 4 First Name

Guest 4 Last Name

Guest 4 Email Address

Relationship to Student

Guest 5 First Name

Guest 5 Last Name

Guest 5 Email Address

Relationship to Student

Saturday Visit Day

Person Scheduling Visit

Student Information

Academic Information

High School Information

College or University Information

Visit Information

Guest Information