Nursing Open House

STUDENT INFORMATION

First Name

Last Name

Email Address

Mobile Phone

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Yes

No

Birthdate

Mailing Address

Country

Street

City

Region

Postal Code

Anticipated type of student

Anticipated program of study

Anticipated start term

ACADEMIC HISTORY

Current school or most recent school if not currently attending
*Please be sure to click on the school if it populates in the drop-down menu.

Self-reported GPA

EXTRACURRICULAR INFORMATION

Do you plan to participate in sport(s) in college?

Yes

No

Do you plan to participate in fine arts in college?

Yes

No

Which ensemble(s) would you be interested in joining?

FAMILY INFORMATION

Family Relationship

First Name

Last Name

Email

Mobile Phone