2+2 Nursing program with Trinity virtual information event

Student first name *

Student preferred name (if different than first name)

Student middle name

Student last name *

Student birthdate *

Student email address *

Permanent address *

Country

Street

City

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Postal Code

Student mobile phone number (Will be used for event communication)*

Primary phone number*

Parent email address (will be used for event communication) *

Student Type*

Anticipated entry term*(Please indicate when you plan to enroll at Augustana)

High school*

Anticipated entry term* (Please indicate when you plan to enroll at Augustana)

Current or most recent institution*

Academic Interest - 1st choice*

Academic Interest - 2nd choice

Activity type

Name

Activity type

Name

Activity type

Name