Info Nights Registration

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Info Nights Registration

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Please select the location of the Info Night you wish to attend from the list below, and fill out the remainder of the form.

Additional Information

Check in will begin at 6:30 pm. Desserts and refreshments will be served and information browse tables will be available during that time. The program will start at 7:00 pm and will wrap up around 8:00 pm.

We look forward to seeing you at Info Nights!

Info Night Date and Location:

First Name:

Middle Initial:

Last Name:

* Gender:

Date of Birth:

(ex. 01/01/1991)

Address:

City:

State:

Zip Code:

Home Phone:

(123-456-7890)

E-mail Address:

Number Attending:

(including student)

Are you a Wisconsin Covenant student?:

Yes

Academic Area of Interest:

Current High School:

Year in High School:

If Senior, please select one:

Are any special accommodations needed?:

Yes

(i.e. wheelchair, sign language interpreter, etc)

Please indicate special accommodations:

(i.e. wheelchair accessibility, interpreter, etc.)

A. Ethnicity: Are you of Hispanic or Latino origin?:

Yes

If yes to Ethnicity A. question, please choose one or more from this list to the right:

Mexican / Mexican American or Chicano

Puerto Rican

Cuban

Other Hispanic or Latino

Part B. Race: Choose one or more from this list::

African American or Black

American Indian or Alaskan Native

Native Hawaiian or Pacific Islander

Cambodian

Hmong

Laotian

Vietnamese

other Asian

White

I choose not to respond

tribal affiliation / other:

If you checked off American Indian, Alaskan Native or other, please specify here