*First Name:

*Last Name:

*Email Address:

*Address:

Address 2:

*City:

*State/Province:

*Zip:

*Phone:

*I am a:  first time freshman transfer student

If you are a first time freshman, what high school did you attend:

If you are a transfer student what school(s) have you attended?

*High School Graduation Year:

Intended Major:

Extra-curricular Interest:

*Choose a date:  February 3-4, 2012 March 23-24, 2012 March 23-24 Soccer Recruitment Day April 20-21, 2012 Other

If other, what dates would you like to visit?

While campus, I would like to speak with:

While campus, I would like to stay with:

*I will arrive on campus:  Thursday night by 8pm Friday morning at 9:30 am Other (please specify in box below)

Arrival Date and Time:

*I will be leaving campus:  Friday afternoon when the Visit Day is finished Saturday morning Saturday afternoon Other (please specify in box below)

Departure Date and Time:

**NOTE** If you are coming on an individual visit we will make time arrangements

*My parents will accompany me  Yes No

Name of parent(s) attending:

Please type what you see: