College of Education Open House

RESERVATION FORM

Contact Information

First Name

Preferred Name

Last Name

Birthdate

Email Address

Should we email your parent/guardian a copy of the confirmation email?

Yes

No

Relationship Type (Hidden)

Parent/Guardian Email Address:

Home Phone

I consent to be contacted by Niagara University at the mobile phone number provided.

Yes

No

Mobile Phone

Do you have any special dietary needs?

Yes

No

What are your dietary preferences?

Any additional guests coming to Open House with you?

Do you or a member of your family have accessibility concerns?

Yes

No

What are your specific needs?

Your Niagara Plans

Anticipated Entry Term

Student Type

High School

High School CEEB Code

High School Level of study (Hidden)

College you currently/or last attended

College CEEB Code

College Level of study (Hidden)

I am interested in the following major at NU

Mailing Address

Country

Street

City

Region

Postal Code