Bear POWER Open House Registration Form

Date: Friday, September 24, 2021
Time: 9 a.m. to 12 p.m. with optional on-campus tours at 12 p.m. or 1 p.m.

Where: Plaster Student Union, Traywick Parliament Room 313

This event will also be available via Zoom.

Deadline for registration: September 10, 2021

Please don't fill out this input box.

Attendee information

First name*

Middle name

Last name*

Street Address*

City*

State*

Zip code*

Phone number*

Email address*

Accommodations Needed*Please describe the accommodations needed. Enter "None" if no accommodations are needed.

Additional Attendee information

Attending As:*

OtherFill out this field if you're attending as someone 'Other' than what is listed above.

Plan to Attend

I will be attending the on-campus tour at the following time:

Additional Attendees*Please list additional attendees and indicate if they are attending as a potential student, a parent/guardian, a family member and educator or another role. Enter "None" if you plan to attend alone.

Additional Attendee Accommodations*Please describe the accommodations needed. Enter "None" if no accommodations are needed.

I am okay with me and my attendees to be photographed and shared for publication.*

Yes

Additional referral information

How did you hear about the Bear POWER Program?

OtherFill out this field if you heard about the Bear POWER Program from a source "Other" than what is listed above.