Oregon Private College Week 2023 Registration

Date of Visit*

Monday, July 24
Tuesday, July 25
Wednesday, July 26
Thursday, July 27
Friday, July 28

Session*

Morning: 9am-11:30am
Afternoon 2pm-4:30pm

Student First Name*

Student Preferred Name (if different from First Name)

Student Last Name*

Student Pronouns

Email*

Student Home Address*

City*

State*

Zipcode*

Student Phone*

Student Birthdate*

School Most Recently Attended

High School Graduation Year

Year Expected to Begin College*

Academic Interest

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Total Number in Party*

Do you need ADA accommodations?

Yes
No

May we contact you with further questions?

Photo Release*

I understand that Bushnell University and the Oregon Alliance of Independent Colleges & Universities may take photos for promotional reasons during Oregon Private College Week. I agree to allow my photo be taken while on the Bushnell University campus.

I Agree

Comments/questions/tell us more

How did you hear about this event?*

Postcard
Email
Social Media
Word-of-mouth
School Staff/Teacher
Community Based Organizations/Nonprofits
The Alliance Website
Alliance Member College or University
Other

Please Specify:

Phone

This field is for validation purposes and should be left unchanged.