Clarkson University K-12 Campus Visit Request Form
Name of School/Program:
Preferred Date of Visit:
Person Filling Out This Form & Title:
Your Phone Number:
Your Email Address:
Contact Person for Day of Visit & Title:
Contact Person Phone Number (Office):
Contact Person Phone Number (Day of/Cell Phone):
Contact Person Email Address:
Number of Students:
Number of Chaperones:
Grades of Students:
HEOP/CUPO Overview or Panel
School of Business - First year class
School of Business - Entrepreneurship Hands-on Activity
School of Engineering - Robotics
School of Engineering - SPEED Labs
School of Arts & Sciences - Computer Science/Programming
School of Arts & Sciences - STEM Activities
Snack (no Clarkson assistance available)
If requesting a meal, how do you plan to pay for your meal?
Clarkson group or department
Your School/Program paying: PO
Your School/Program paying: Check
Your School/Program paying: Cash
Your School/Program paying: Credit Card
Requesting Clarkson Assistance
If being paid for by Clarkson group or department, list the group/department here. If requesting Clarkson assistance explain the reasoning for request.
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