Academic Immersion Day

Form Date (Hidden)

Student Information

First Name

Preferred Name

Last Name

Birthdate

Gender

Female

Male

What is your t-shirt size?

Contact Information

Mailing Address

Country

Street

City

Region

Postal Code

Email Address

Please confirm your email

Student Cell Phone

Can we text you details about your upcoming visit?

Yes

No

Parent/Guardian Phone

Parent/Guardian Email

Academic Information

You are interested in Benedictine College as a...

When do you plan to start at Benedictine College?

Current or Most Recent High School or College

School CEEB

Are you currently being homeschooled?

Yes

No

Visit Information

How many guests will accompany you?

Please let us know any additional information that will help us prepare for your visit

Dietary Restrictions

Walking Tour Accommodations

Questions/Concerns

Please let us know any additional information that will help us prepare for your visit. We will do our best to accommodate such requests.

Any photos and videos taken by Benedictine College on campus may be used for promotional and institutional purposes.