Queens University of Charlotte

Please take a few moments to complete this form. We'll get
in touch with you personally to arrange your campus visit.

For special requests (visiting a class, meeting a professor, etc.)
please give us at least one week's advance notice.

Fields marked with an asterisk * are required.

*First name:

*(Preferred:)

Middle Init.:

*Last name:

*Street Address:

*City:

*State:

*ZIP Code:

*Email address:

*Phone:

* Male
* Female

Date of Birth:
(mm-dd-yyyy)

Phone type (home, cell, other):

Name of your
high school:

City and state:
(or province, etc.)

Year you will
graduate:

GPA:

PSAT:

SAT:

PLAN:

ACT:

Name of the college
or university:

City and state:
(or province, etc.)

Current class year:
(freshman, soph, etc.)

What is your country of citizenship?

You can visit MONDAY through FRIDAY, at 10 am or 2 pm.

*I would like to visit Queens on this date, at this time:

Month

Day

Time

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

I would like to schedule...
An Admissions interview
A tour of the campus
A class in session
A visit with a professor
A visit with a coach
A meeting with Financial Aid

For special requests, please give us at least one week's advance notice.

*I am interested in studying...

1.
2.
3.

I am also interested in:

	Athletics -- What sport(s)?

	Internships
	International Travel
	Community Service

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?