* denotes required field

PLEASE INDICATE YOUR VISIT PREFERENCE

Schedule my customized 155th Anniversary Sensational Fayette Campus Visit Experience

   Date:

   Day:

   Name of Parent/Guardian who will be with me:

   I will need an overnight hotel stay Yes No

   Date of night needed for overnight hotel stay:

 I would like an overnight stay in the residence halls Yes No

   I will be driving miles to campus.

      I will be flying to campus. Please contact me about pick-up arrangements

Visit Day programming begins at 8:30 a.m. and concludes at 3 p.m.

Attend October 19, 2013 Visit Day

Attend October 21, 2013 Visit Day for Transfers

Attend November 15, 2013 Visit Day

Schedule an individual visit

Dates for Spring visit days will be announced later.

PERSONAL INFORMATION

*First Name:

*Last Name:

*Gender:      Female    Male

*Address 1:

Address 2:

*City:

State: Please select . . . Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico New York Nevada Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Wisconsin West Virginia Wyoming

*ZIP:

*Phone number:

*E-mail address:

*Verify your e-mail address:

*High School Graduation Year:

*High School Name:

*High School City/State:

Have you previously or are you now attending college? Yes No

Expected start date at UIU:

Area(s) of Academic Interest (Major):

Number of Additional Guests Attending:

I'd like to receive information about:

How did you hear about UIU?

Preferred Date for Visit:

Preferred Time for Visit: