Student's Name: *

Street Address: *

City/State/Zip: *

Telephone No.:

Email Address: *

Areas of Interest/Possible Majors: *

Current High School Status: *

Have you been offered admission to Penn State: *

Yes

No

If you have been offered admission, are you interested in participating in student evening activities on March 16th (to include dinner): *

Yes

No

If you have been offered admission, are you interested in staying overnight in a dorm room March 16th: *

Unavailable

Regretfully, we are unable to accommodate any more prospective students overnight in the dorms due to the high demand. However, prospective students can still sign up to shadow a current student to classes and attend the evening dinner and activities at the EMS Interest House on Friday, March 16th.

For accommodation purposes, please indicate your gender:

Male

Female

Expected arrival date:

Expected arrival time:

:

am

pm

Number of People Who Will Be Attending (Not Counting Student): *

Parent Dinner Reception Registration

PARENT(S)/LEGAL GUARDIAN(S) OF 'OFFERED ADMISSION' STUDENTS ONLY: You are cordially invited to a complimentary "get acquainted" buffet dinner at the Atherton Hotel. While your student is enjoying other planned activities, we are looking forward to meeting you. Nels Shirer, Associate Dean for Undergraduate Education, our Director of Academic Advising, and Stacy Davidson, our Recruiter/Advisor, will also be available. We look forward to meeting you.

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EMEX 2012 Family Registration Form

Parent Dinner Reception Registration