Summer Visit Day

Monday, July 22, 2024 at 9:00 AMCentral Daylight Time UTC -05:00

The Gerber Center for Student Life
3435 9 1/2 Ave
Rock Island, IL 61201
United States

Student Information

Student first name *

Student preferred name (if different than first name)

Student last name *

Student birthdate *

Student email address *

Permanent address *

Country

Street

City

Region

Postal Code

Primary phone number*

Mobile phone number * (will only be used for event communication)

Student Type*

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

High school*

Current institution*

Intended Major - 1st choice*

Intended Major - 2nd choice

Would you like to request a tour in Spanish?

Yes

Parent or Guardian Information

Name(s)

Parent email address *