Visitation Form

Student Outreach Ambassador Visitation Form

Fields in red are required information
Visitation Contact Information:
Name of Organization or Program:
First Name:	Last Name:
Phone Number:	() - Cell Number: () -
E-Mail:	If you have more than one emails, separate them by a comma.
How did you hear about the Student Outreach Ambassador Program?
Logistical Details: (fills in the red fields and any other that applies)
Location:	On Campus Off Campus
Arrival Date:	Departure Date: Format: MM/DD/YYYY
Arrival Time:	Departure Time: Format: HH:MM If you have more than one time range, please indicate in comment area below
Number of Vehicles:	Number of students:
Number of Underrepresented Students:
Grade Level:	Press control key to select multiple items
Preferred Activities:(Checks all that apply) Admissions Presentation (30 - 45 min.) Campus Tour (75 min.) Class Visit (50 min.) Financial Aid Workshop (30 min.) Student Panel Presentation (60 min.) Motivational Workshop (60 min.) Lunch on Campus (60 min.) Other
Please briefly indicate what ethnicity this group will consist of:
Comments and other requests: (information that does not fit the above fields)