PennWest Clarion Spring Open House

Student Email Address

Student First Name

Student Preferred First Name (Enter only if different from your first name above.)

Student Last Name

Birthdate

Phone Number

Mailing Address

Country

Street

City

Region

Postal Code

What school have you most recently attended? (Start typing and choose from drop down)

When would you like to start?

What type of student will you be?

Are you studying on campus or online?

On Campus

Online

What will you study?

How many guests will be attending including yourself?

Do you have any dietary restrictions?

Yes

No

Please explain.