Undergraduate Health and Human Performance Academic Tour

Monday, April 10, 2023 at 1:15 PM until 2:00 PMEastern Daylight Time

Plymouth State University
17 High St
Plymouth, NH 03264
United States

Name and Contact Information

Student First Name *

Preferred Name

Student Last Name *

Preferred Pronouns

Personal Email *

Mailing Address *

Country

Street

City

Region

Postal Code

Home Phone

Mobile Phone *

Please send me text updates (never miss an event or deadline)

What is your preferred method to receive communication from us?

Birthdate *

Academic Information

I currently attend/ Most recently attended *

School Name *

Anticipated Entry Term *

Anticipated Major/Program *

Parent / Legal Guardian Information

Parent \ Guardian Frist Name

Parent \ Guardian Last Name

Parent \ Guardian Email

Relationship Type

Guest Information

How many guests will be joining you? *

Will you or your guest need ADA accommodations?* If yes, please describe: