Open House Registration

  • Date attending:

    Number attending:

    First Name:

    Last Name:

    Address:

    City:

    State:

    Zip:

    Phone:

    High School Name:

    Graduation Year:

    Have you attended another
    college?
     

     

                     

     

     

    If yes – what school? 

     

    Intended Major:

      

    E mail: