Select Your Visit Date

Visit Date:

Student Name and Contact Information

First Name:
Last Name:
Street Address:
Zip Code:
Phone Number:

Parents or Guests Attending

limit two per student

Full Name:
Is guest Valpo alum?
Full Name:
Is guest Valpo alum?

Academic Information

Name of High School or College:
High School Graduation Year:
Interest in Which Major:

Comments/Questions/Special Needs

After submitting your registration form, please check your email-box to see if the information you submitted was accurate; if you find an error, email us at .
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