Are You Ready for College? Registration Saturday, December 7, 2013
Student Last Name*:
Student First Name*:
Student Middle Name:
Address*:
Address Line 2:
City:
State:
Zip:
Email*:
Confirm Email*:
Student Date of Birth*: / /
Phone:
How many people are you bringing with you?*
(Excluding student, maximum 2) :
(excluding student)
High School:
College:
Incoming Student Type*:
Major of Interest*:
Intended Term of Entry*: