Schedule An Appointment

Your Personal Information

Full Name:

First *

Middle

Last *

Date of Birth

Month

Day

Year

Gender

Your Contact Information

E-mail Address *

Mobile phone

(###)( )

### -

####

Your Emergency Contact Information

Name: *

First

Last

Phone:

(###)( )

### -

####

E-mail: *

Relationship to Student: *

Your Physical Address

Address Line 1

Address Line 2

City

State or Province

Other State or Province

Nation

Postal Code

Your Mailing Address

Mailing Address is the same as Physical Address. YesNo

Address Line 1

Address Line 2

City

State or Province

Other State or Province

Nation

Postal Code

Your School Information

Current School/College *

City

State or Province

Your Academic Interests

Tell us about the academic programs you're interested in pursuing in college.

First Intended Major

Second Intended Major (If Applicable)

Your Co-Curricular Activities

Tell us a little more about your co-curricular activities (You can add additional activities by clicking on the "Add" link at the bottom of this section.).

Activity

Academics

Art

Athletics

Clubs and Organizations

Music

Student Media

Theatre & Dance

Other

What instrument do you play?

Would you like to continue this activity at PLU?

Add

Your Travel Information

I will be visiting on this date: *

I will be arriving at this time: *

I need to leave by this time: *

Including yourself, how many will be attending the visit? *

I am coming to PLU by means of: *

Your Flight Information

Arrival Date:

Arrival Time:

Airline:

Flight #:

Shuttle pick-up Yes, I need a shuttle pick-up

Departure Date:

Departure Time:

Flight #:

Shuttle drop-off Yes, I need a shuttle drop-off

Visit Options

On my visit I would like to (Check all that apply):

Take a Campus Tour (one hour, Mon-Fri - 9:30, 10:30, 12:30, 2:30)

Meet with an Admission Counselor

Meet with a Financial Aid Counselor

Meet with a coach

Meet with a music instructor

Have lunch in our University Center Commons

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