Campus Visitation

    To better serve you please fill out this 2 part form. Required Fields are denoted by asterisks. *
Students Name:*
(First, Middle, Last)
Classification:*
Students School:*
Email Address:*
Mailing Address:*
City:*
State:*
Zip Code:*
Home Phone Number*
This will be our primary means to confirm your visit.
Cell Phone Number
Is the student a child of an Alumni?* No    Yes
Does the Student have A Visual, Auditory or Physical impairment we should be aware of? *
Please describe the nature of the student's impairment so that we may better facilitate their visit. *
Will family or friends be joining you on this visit? Pamela Bruce
Kenneth R Simmons
Does your group have more then one prospective Student? If you have a another prospective student that will be on the trip
please fill out their information separately by pressing on the
"Add Another Student" button.