Clarkson University K-12 Campus Visit Request Form
Name of School/Program:
Your answer
Preferred Date of Visit:
MM
/
DD
/
YYYY
Alternative Date:
MM
/
DD
/
YYYY
Person Filling Out This Form & Title:
Your answer
Your Phone Number:
Your answer
Your Email Address:
Your answer
Contact Person for Day of Visit & Title:
Your answer
Contact Person Phone Number (Office):
Your answer
Contact Person Phone Number (Day of/Cell Phone):
Your answer
Contact Person Email Address:
Your answer
Number of Students:
Your answer
Number of Chaperones:
Your answer
Grades of Students:
Your answer
Arrival Time:
Your answer
Departure Time:
Your answer
Interested In:
If requesting a meal, how do you plan to pay for your meal?
If being paid for by Clarkson group or department, list the group/department here. If requesting Clarkson assistance explain the reasoning for request.
Your answer
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