Fall Open House

Is this form being filled out by the student? *

Yes

No

Your Information

What is your relationship to the student? *

Your First Name *

Your Last Name *

Your Email Address *

Your Mobile

I authorize text messages to the mobile telephone number above and accept responsibility for any charges incurred. *

Yes

Student Information

Student First Name *

Student Last Name *

Student Preferred First Name

Student Pronouns

Student Birthdate *

Student Email Address *

Student Mobile

By providing my mobile number, I authorize text messages to the number above and accept responsibility for any charges incurred. *

I acknowledge

Intended Start Term *

Intended Start Year *

Student Type *

Intended Major *

Instrument *

Current High School *

Anticipated Graduation Date *

Most Recent College or University Attended *

Mailing Address

Country

Street

City

Region

Postal Code

Would you be considered a first-generation college student? (Neither parent graduated with bachelors degree)

Yes

How many people will be accompanying the student to Open House?

Have you previously attend the Pacific Summer High School Institute?

Yes

If you require any dietary or physical accommodations to participate in the event please list them here.