Susquehanna First Look

Student Information

Student's First Name *

Student's Preferred First Name (name you would like on your name tag if not your first name)

Student's Last Name *

Preferred pronouns to appear on nametag (optional)

Student's Birthdate*

Mailing Address *

Country

Street

City

Region

Postal Code

Student's Email Address *

Cell Phone *

Home Phone

Academic Information

Current School *

Entry Year *

I am a prospective *

Intended Major

Parent/Guardian Information

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Email Address *

Relationship Type*

Visit Information

Number of Guests (not including the student) *

Do you have a guest(s) that is a parent or grandparent who has graduated from Susquehanna University?

Yes

No

Please enter the name(s) and grad. year(s) of your legacy parents/grandparents below:

Enter a guest email below if you'd like them to receive First Look confirmation & reminder emails.

Special Accommodations/Comments