Individual Visit

First Name *

Last Name *

Street Address *

Address (cont.) *

City *

State/Province *
OtherAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY

Zip/Postal Code *

Home Phone *

E-mail *

Preferred Contact *
 Phone     E-mail

Gender *
 Male     Female

Please note the following dates Will NOT qualify for Visit Scholarship:
Tuesdays and Thursdays
October 14, December 12-January 10, 16, February 20, March 26-30, April 6, 30-August 29th, 2012 Admissions Office Closed:
Weekends, Weekdays after 5pm until 9am
November 23-25, December 23-26, 30, 2011, January 2, February 20, May 28, July 4, 2012

What date would you prefer to visit? *
MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberDay01020304050607080910111213141516171819202122232425262728293031Year2008200920102011201220132014201520162017201820192020

Are you interested in meeting with a professor?
 Yes     No

Which department?

Name of Professor, if any?

Are you interested in meeting with a coach?
 Yes     No

Which sport?

Will anyone be joining your visit? (Parent(s), Guardian, Friend, Youth Leader)
 Yes     No

Name(s) of guest(s)?

One week notice is requested for visitors who would like to stay in the residence hall. *

Are you interested in staying in a residence hall with a student host?
 Yes     No

Name of requested student host, if any?

High School

Graduation Year
Select19501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020

Transfer College

Home Church

Major Interest

Athletics Interest

Additional Comments