Junior Reality Check
Friday, March 28, 2008
On-line Registration


First Name


Middle Name


Last Name


Street or Mailing Address

City
State
Zip Code


Phone Number including Area Code


E-mail Address

Name of High School
Month of Graduation
Year of Graduation


Previous University(s) attended/attending

Academic Interests
Other Information You Would Like to Share

Mode of Communication Preferred		 Hold Control Key Down to Make Multiple Selections

Type of Amplification
People attending with You
  First & Last Name Address including City, State, Zip E-mail Address Phone Number Relationship to You
(Parent, Teacher, etc.)
Person 1
Person 2
Person 3
Person 4
Person 5

(Please only hit submit once.)