Fall Open House

*Required

First Name*

Preferred First Name (e.g. Jon for Jonathan)*

(The name placed here will be used in print and digital communications, including those sent to parents/guardians.)

Middle Name

Last Name*

If you would like your pronouns to appear on your printed name tag at open house, please provide them below. (If you would not like your pronouns to appear on your printed name tag, please skip this question.)

He/Him

She/Her

They/Them

Add another pronoun set

Your pronouns:

Sex*

Female

Male

X or another legal sex

Birthdate*

Permanent Address*

Country

Street

City

Region

Postal Code

Is your Mailing Address the same as your Permanent Address*

Yes

No

Mailing Address*

Country

Street

City

Region

Postal Code

Student Home Phone

Student Mobile Phone

I give permission to be contacted by Bucknell via mobile phone, which may include phone calls or text messaging.

Student Email Address*

Confirm Email Address*

Parent 1 Email Address*

Parent 2 Email Address

Student's High School*

High School CEEB Code

Expected High School Graduation Year*

Primary Academic Interest*

Secondary Academic Interest (if applicable)

Additional Academic Interest (if applicable)

How many people will attend (including the student)?*

Please indicate if you or a family member may need special assistance, including accommodations or dietary requirements.

Fall Open House

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