Queens University of Charlotte

We are excited that you have chosen to visit Queens. Please take a moment to complete this form so we can register you for the event.

Note: Fields marked with an asterisk * are required.

* I wish to register for this event:

February 7, 2010 (North Carolina Teaching Fellows Open House) Agenda
February 12-13, 2010 (Scholars Weekend and Admitted Students Day)
April 24, 2010 (Preview Queens, for juniors)

*First name:

*(Preferred:)

Middle
Init.:

*Last name:

*Street Address:

*City:

*State:

*ZIP Code:

*Email address:

*Home Phone:

* Male
* Female

Date of Birth:
(mm-dd-yyyy)

Cell Phone:

*High School:

*Year of Graduation:
(yyyy)

GPA:

PSAT:

SAT:

PLAN:

ACT:

*My interest in Queens University of Charlotte is...
One of my top choices
I plan to apply
One of several I am considering
I am requesting initial information

*Intended area(s) of study: (Please select at least one, or "undecided")

First Choice	Second Choice
Third Choice

Please tell us how many people will be accompanying you on your visit:

Parents/Family	Other interested students
Queens Alumni (other than family)	Others

Are there any special needs we should be aware of to help plan your visit?

Is there anything you would specifically like to ask us?