Elevation of Excellence - University of Arkansas Pine Bluff Homecoming Tour 2024
October 23-27, 2024
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Email *
Student's Name
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Student's email address
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Student's phone number
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Student's Home Address
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Parent/Guardian Name
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Parent/Guardian email address
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Parent's phone number
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Parent/Guardian Home Address (if different from student)
Student's Date of Birth
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School Currently Attending (2024-2025)
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Student's Grade Level (2024-2025)
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What is your current GPA? *
Please enter your School ID#
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What major are you interested in pursuing? *
Required
Does your student have any medical conditions or disabilities that we need to be made aware of for this tour?
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If you answered "Yes" to the previous question, please list any current medical conditions or disabilities
Of the schools listed on the tour, which are your top 2 schools of interest? *
Required
In case of medical emergency, please list your insurance and member ID#
*
What is your t-shirt size?
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Do you have your deposit of $250 secured to pay today?
*
A copy of your responses will be emailed to the address you provided.
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