To register for a Discover Days Visit Program, please complete this form and click on the Submit button.

Mr. Ms.

First Name Last Name

Address

City State Zip

Telephone Email

Number Attending

High School

Graduation Year

Birth Date (month, day) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year

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Intended Major

Please select a date for your visit

I will be attending: May 18 June 29 July 20

What first prompted you to register for a Discover Day? Newspaper Ad Web Site Mailed Invitation Counselor Visit College Fair Phone Call from UPT Student Other

      Other:

What other ways did you hear about Discover Days? (Check all that apply.)

       Newspaper Ad
       Web Site
       Mailed Invitation
       Counselor Visit
       College Fair
       Phone Call from UPT Student
       Other

Additional Requests/Comments