Nursing Open House

Student Information

* First Name

Preferred Name

* Last Name

* Birthdate

* Mobile number

* Would you like to receive text messages (Learn more about Clinton's text messaging policy and how to opt out.)

Yes

No

* Email Address

Would you like to be added to our mailing list?

Yes

No

* Mailing Address

Country

Street

City

Region

Postal Code

Academic Information

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School CEEB

* I will enter as a

* Program of Interest

* I plan to start college in

Event Information

* How many guests will be accompanying you (please do not include yourself in this count)?

Will you be bringing a vehicle to campus?

Yes

No