College Day - STUDENT

COLLEGE DAY REGISTRATION

Name:*

First Name

Last Name

Date of Birth (mm/dd/year):*

Address:*

Address Line 1

Address Line 2

City

State

ZIP Code

Country

Phone: *

Email:*

Current School *

Current Grade:*

Which College Day do you plan to attend?

Have you applied to VC?*

Yes No

Will any parent/guardian be accompanying you on the visit?*

Yes No

Name(s) of Parent / Guardian(s) who will be accompanying you: *

How did you hear about College Day?*

Additional comments or special accommodations needed (dietary/disability):

Promo Code

Credit Card

Total $

Number