Interested in Pre-Health or a Pre-Law Pathway

Personal Information

Student's First Name

Student's Last Name

Birthdate

Contact Information

Student's Email Address

Mailing Address

Country

Street

City

Region

Postal Code

Student's Mobile Phone Number

I'd like to receive texts from Allegheny:

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Yes

No

Academic Information

High School Name

CEEB

Anticipated College Start Term

Additional Information

Academic Interest

Second Academic Interest

Would you like to provide your parent's information?

Yes

No

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Please choose one:

Attendance Information

Who will be attending this virtual event?

Student

Parent or other

Both

Do you have any comments or any questions you would like answered during this online event?

Please read this statement and initial below to indicate your agreement: I understand that as a part of this programming there may be opportunities for me to interact via video and audio where appropriate. I agree to follow the host's instructions as to when I should be on camera, using audio, or communicating via the chat function. I acknowledge that inappropriate use of the platform may result in my removal from the program.*

Allegheny College Privacy & Security Statement for Submission of Information via the Web