Pre-Health Sciences Experience Day

STUDENT INFORMATION

First Name

Last Name

What are your preferred pronouns?

Email Address

Mobile Phone

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Yes

No

Birthdate

Mailing Address

Country

Street

City

Region

Postal Code

Please list country of citizenship

Anticipated type of student

Anticipated program of study

Secondary Education Subject Area

Campus location you wish to take your courses

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 High School GPA

EXTRACURRICULAR INFORMATION

Are you interested in playing a sport in college?
*please use CTRL + click to select multiple options

Are you interested in participating in music in college?

Choir

Music Ensemble

What instrument(s) do you play?

FAMILY INFORMATION

Family relationship

First Name

Last Name

Email

EVENT INFORMATION

How many people will be joining you?

Will you or your guests need accommodations in the following areas? (select all that apply)
*please use CTRL + click to select multiple options

Other Accommodations (please explain)

Do you or your guests have any food allergy restrictions? (please explain)

Please select the optional sessions you would like to add-on to your schedule. Please do not select more than one for each time.