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Campus Visit Day Registration Form
First name
*
Last name
*
Email
*
Please list your personal email, not a high school email account.
Phone number
*
Program of Interest
*
Please Select
Associate of Science in Radiography (ASR)
Diagnostic Medical Sonography (DMS)
Cardiac Sonography (DCS)
Public Health (PH)
Medical Imaging (MI)
Bachelor of Science in Nursing (BSN)
Medical Laboratory Science (MLS)
Total Number of Guests
Name of High School Attending/Graduated
*
Please Select
AGWSR High School
Alburnett Sr. High School
Aplington Parkersburg High School
BCLUW High School
Belle Plaine Junior/Senior High School
Benton Community Senior High School
Center Point-Urbana High School
Central City High School
Clarksville High School
Denver Senior High School
Dike-New Hartford High School
Don Bosco High School
Dunkerton High School
East Buchanan High School
East Marshall Sr. High School
Gladbrook-Reinbeck High School
Green Mountain-Garwin High School
Grundy Center High School
Independence Junior/Senior High School
Janesville Junior/Senior High School
Jesup High School
Maquoketa Valley Senior High School
My High School Doesn't Appear On This List
My High School Is Outside The State of Iowa
Nashua-Plainfield Jr./Sr. High School
New Hampton High School
North Butler High School
North Fayette Valley High School
North Tama High School
North-Linn Sr. High School
Rockford Jr/Sr. High School
South Hardin High School
South Tama County High School
Starmont High School
Sumner-Fredericksburg High School
Tripoli Middle/Sr. High School
Union High School
Vinton-Shellsburg High School
Wapsie Valley High School
West Central Charter High School
West Fork High School
West Marshall High School
Year of High School Graduation (or anticipated grad year)
Date of birth
Month
/
Day
/
Year
Date of Campus Visit Day
*
March 14, 2025 (9-11:30 am)
April 25, 2025 (1-3:30 pm)
June 13, 2025 (9-11:30 am)
July 18, 2025 (9-11:30 am)
T-shirt Size (Adult Sizes)
Please Select
Small
Medium
Large
XL
XXL
XXXL
Photo Release Confirmation
By submitting this form, I verify that I have given permission for the reproduction and use of my picture in the materials connected with Allen College.
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