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Event Information Request

Student's Name:
First Name:
Last Name:
Address:
Street Address:
City:
State:
Zip:
Country:
Home Phone:
Cell Phone:
Email Address:
High School Information:
High School name:
High School city:
Anticipated entrance status:
First-Year Student
Transfer student from:
Expected date of enrollment:
Fall Term Winter Term Spring
2014 2015 2016 2017
Visit Days
Experience Augustana - for admitted seniors
Augustana Spring Preview
Augustana Summer Academy
Academic Department Open House & Scholarship Competition
Transfer Fridays - transfer visit days
Optional Information
Gender: Male Female
Are you Hispanic/Latino: Yes No
Ethnic Background (check all that apply):
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White