NOVA Vision Conference 2021: Student Registration
Tuesday, April 20, 2021
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First Name/Nombre *
Middle Initial
Last Name/Apellido *
Street Address
(Include apartment/unit numbers)
City
State
Zip Code
Date of Birth
MM
/
DD
/
YYYY
Phone Number
Email address (We will forward the meeting link to this email address) Dirección de correo electrónico (reenviaremos el enlace de la reunion a esta dirección de correo electrónico) *
Please list the name of your high school/program:
Anticipated year of high school graduation:
When do you want to start classes at NOVA?
Clear selection
What do you want to study at NOVA?
Clear selection
Please list any additional info you would like NOVA to send to you:
If you require language interpretation and/or ADA accommodations to participate, please indicate your needs below. Si Necesita interpretación y/o adaptaciones de la ADA para participar, indique sus necesidades.
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