Queens University of Charlotte

We are excited that you have chosen to Discover 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:

Super Saturday, Saturday, June 21st, 2008
Super Saturday, Saturday, July 26th, 2008

*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?