Evening with Elon in Chicago, IL

*Number of guests accompanying the student:

Contact Information

*Student First/Given Name

Student Preferred Name (if different from first name)

*Student Last/Family Name

Suffix

*Birthdate

*Sex

Female

Male

X - or another legal sex

*Student Email Address

Home Phone

Cell Phone

By providing your number, you consent to receive notifications from this organization. Reply STOP to unsubscribe. Msg & Data rates may apply.

*Mailing Address

Country

Street

City

Region

Postal Code

Parent/Guardian Contact Information

Relation to student

Parent/Guardian 1 First Name

Parent/Guardian 1 Last Name

Parent/Guardian 1 Email

Parent/Guardian 1 mailing address same as student

Yes

No

Parent/Guardian 1 Mailing Address

Country

Street

City

Region

Postal Code

Would you like to provide a second parent/guardian?

Yes

No

Relation to student

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Email

Parent/Guardian 2 mailing address same as student

Yes

No

Parent/Guardian 2 Mailing Address

Country

Street

City

Region

Postal Code

Optional

Do you consider yourself to be Hispanic or Latinx?

Yes

No

Race- check all that apply

Academic Interest

*I plan to enter college in:

*As a:

First-year

Transfer

Current Academic Information

*Current School

CEEB

Admissions

Evening with Elon in Chicago, IL

Contact Information

Parent/Guardian Contact Information

Optional

Academic Interest

Current Academic Information