Misericordia University: August Open House

Student First Name

Student Last Name

Student Birthdate

Student Email Address

Student Cell Phone Number

Student Mailing Address

Country

Street

City

Region

Postal Code

With which student type do you best identify?

What would you like to study?

When would you like to being taking classes?

How many guests will be attending with you (not including yourself)?

Family Member or Guardian Type

Family Member or Guardian First Name

Family Member or Guardian Last Name

Family Member or Guardian Email

Family Member or Guardian Phone Number

Special Accommodation Request

Wheelchair

Food Allergy

Other

Let us know how we can accommodate you.

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