Academic Scholarship Day

Student Information

Student first name *

Student preferred name (if different than first name)

Student last name *

Student email address *

Birthdate *

Primary phone number *

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

Have you applied to Augustana College?*

Yes

No

*In order to be eligible for the scholarship competition, you must apply by Dec. 1.

*In order to be eligible for the scholarship competition, you must apply before the event.

Permanent address*

Country

Street

City

Region

Postal Code

Student Type *

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

Choose an academic session/competition to attend *

*Please note: The Art, Music and Theatre scholarship competitions require you to audition or participate in a portfolio review the day of the event.

Would you like a campus tour? *

Yes

No

Would you like to join us for a complimentary lunch during your visit?*

Yes

No

Please provide a mobile phone number for each guest who will be dining the day of the event. Students will be sent their lunch pass to the mobile number they provided above. Lunch passes will be texted to each number the day of the event.

Guest 1 Mobile Phone Number

Guest 2 Mobile Phone Number

Guest 3 Mobile Phone Number

Guest 4 Mobile Phone Number

Guest 5 Mobile Phone Number

Parent or Guardian Information

Name(s)

Parent email address *