March Break Open House Registration Survey

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1. Please enter the following information (if more than one student is attending, please complete a separate booking for each student)

Please enter the following information (if more than one student is attending, please complete a separate booking for each student) Student First Name:
Student Last Name:
Student Address:
Address 2:
City/Town:
Prov/State:
Postal Code/Zip Code:
Country:
Email Address:
Phone Number:

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2. Current Grade/Level


Grade	Current Grade/Level Grade

Other (please specify)

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3. Please let us know if you will be attending the March Break Open House on Monday March 11 or Tuesday March 12.

Please let us know if you will be attending the March Break Open House on Monday March 11 or Tuesday March 12. Monday March 11

Tuesday March 12

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4. How many guests will you be bringing to the Open House? Please do not include the student in this number.

How many guests will you be bringing to the Open House? Please do not include the student in this number. Number of Guests:

5. Which program(s) at Queen's interest you? Choose up to three.


Programs:	Which program(s) at Queen's interest you? Choose up to three. Programs:

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6. Are you interested in Queen’s University Aboriginal Student Services and Programs?

Are you interested in Queen’s University Aboriginal Student Services and Programs? Yes

No

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7. Application Status


Have you applied to Queen's?	Application Status Have you applied to Queen's?

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8. Offer of Admission


Do you have an offer of admission to Queen's?	Offer of Admission Do you have an offer of admission to Queen's?

If so, what program?

9. We welcome persons with disabilities or other special needs. Please let us know how we can serve you best.

We welcome persons with disabilities or other special needs. Please let us know how we can serve you best.

10. Please let us know what you would like to see at the March Break Open House.

Please let us know what you would like to see at the March Break Open House.