Fall 2017 Host-A-Day Form
The Fall 2017 Host-A-Day program is for any prospective students interested in visiting the University of Maryland. Fall visitation dates are M-F, October 2 - November 22 (excluding October 9th) between the hours of 8:30 a.m. and 3:00 p.m.

Requests to be hosted MUST be submitted AT LEAST 2 WEEKS prior to the date you wish to visit. Requests for the Fall 2017 semester will be accepted through November 9th. While we will do our best to accommodate requests, we cannot guarantee availability. Spaces will be filled on a first come, first served basis. Please allow adequate time, generally one full week from the date of your request submission, to receive information regarding the scheduling of your visit.

First Name
Your answer
Last Name
Your answer
Email
Your answer
Cell Phone
Your answer
Home Phone
Your answer
Potential Major(s) / Field(s) of Interest
Your answer
AT LEAST THREE (3) Available Dates For A Visit
Several dates are requested so that we may provide the best opportunity to pair you with a current student. This is not always an easy task as many students have no classes on Fridays, or may only have major courses on Tuesdays and Thursdays, or might intern three days a week. Thank you in advance for your understanding and flexibility.
MM
/
DD
/
YYYY
MM
/
DD
/
YYYY
MM
/
DD
/
YYYY
Other Dates:
Your answer
Mailing Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
High School
Your answer
Parent/Emergency Contact(s): Name, email address, telephone numbers
Your answer
Notes/Concerns
Is there anything else you would like to note about your visit?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms