Visit Registration Information

This is an internal form used for obtaining information to schedule a visit.
Visits are not confirmed until we send an e-mail confirmation letter.
This information will be sent to Karen's e-mail when you hit 'send'.

Let Karen's office schedule Saturday visits as we try and keep them close together for the on duty counselor.
We don't want one at 8 and one at 11 only - if possible.

Block break days - schedule visits on the hour.

Thank you for your help.

Visit Registration Information

Visit date (be sure and check if class day) include day of week: *
Start time (8:45, 9:45, 11:00, 12:45) online time options. Do not schedule later than 9:45 on Fridays: *
Gender: *		Male Female
First name: *
Last name: *
E-Mail: *
Address: *
City: *
State: *
Zip: *
Phone number : *
This phone number is my: *		home phone number cell phone number
Anticipated number of visitors: *
School you currently attend: *
City/State of school (if not hometown):
Year of graduation: *
Academic interests the student may be leaning toward (can use undecided):
Extracurricular Activities the student may be interested in participating in college (sports, music, theatre, religious groups, community service, newspaper, etc):
What to include in visit (specific classes are not guaranteed):		1 hour classroom visit Admission interview Campus tour (11:00 & 3:00 on class days)
If senior - is an evening or overnight stay requested? encourge evening over ON:		No Yes, 5pm - 10pm evening before including dinner Yes, 4pm-9pm following afternoon visit, dinner included Yes, 6 pm the night before including breakfast Yes, 4 pm following afternoon visit, includes dinner and breakfast
For overnight guests - Emergency contact name and phone number:
Additional requests (will try to accommodate requests, but make no guarantees):		Meeting with Coach Meeting with Dimensions (pre-med,pre-vet,pre-dental) Meeting with Berry Center (economics, business, public policy) Meeting with Pre-Law
Meeting specifics (sport,what area of dimensions,etc):
Additional requests (only if they ask, no guarantees: professor meeting, off campus studies, music rehearsals,theatre productions, special needs/disabilities, etc):
Would they like the confirmation letter copied to another e-mail address? If so enter it here:
Submitted by (first name):
A confirmation letter will be sent via e-mail that will include a link to a campus map, area accommodations and contact information for our visit coordinator. If we have any difficulties with scheduling any part of your visit, we will call. Otherwise watch for the confirmation via e-mail. Do you have any additional questions for me? Thank you for your call

* Required Field