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Engineering and Computing Day

  Event Name*
  Event Date/Time*
  Event Location*
  Total Attending*
(Including Student)

If more than one student in your party will be attending, please register separately
  Student First Name*
  Student Middle Name
  Student Last Name*
  Country*
  Street Address Line 1*
  Street Address Line 2
  City*
  State*
  Zip/Postal Code*
  Email*
Please use student email
  Cell Phone Number
123-456-7890
  Student Type*
First Year=Currently attending high school
Transfer=Attended college after graduating high school
  Race
Select one or more
  Entry Term*
Fall 2014=Graduating from HS in 2014
Fall 2015=Graduating from HS in 2015
Transfer Students - choose desired Fall or Spring start date
  Does anyone in your party have special needs?*
  Academic Interests*
  Parent/Guardian Email
 
Engineering and Computing Day