Scholarship Competition Registration

Contact Information

First name: *

Middle name:

Last name: *

Street address: *

City: *

State: *

Zip code: *

Country:

Home phone number:

Cell phone number: *

Email address: *

Please use the fields below if you have a parent/guardian who would also like information on your campus visit.

Additional email address:

Name for additonal email address:

Personal Information

Gender: *

Male

Female

Possible major / Area of interest:

Select multiple entries by holding the CTRL key (or Command key on Macs) while clicking on the items you want to select

Schedule

I will be attending the Scholarship Competition on:: *

Who will accompany you on your visit?:

Lodging

Scholarship Competition activities include spending Thursday night in the residence hall with a student host.

Choose one::

Please place me with an Asbury student in an Asbury Residence Hall

I have made plans to stay with a current student in a Residence Hall

I have made other arrangements off campus

If staying with a current student, please list his or her name:

Optional Information

Additional comments: