PennWest-Edinboro Summer Art Day

Email Address

First Name

Preferred First Name (Enter only if different from your first name above)

Middle Name

Last Name

Birthdate

Mailing Address

Country

Street

City

Region

Postal Code

Phone Number

Student Type (First Year = First-Time College Student; Transfer = Current or Former College Student)

Most recent high school attended?

Most recent college attended?

Please select your intended start date.

Are you studying on campus or online?

On Campus

Online

Select Applied Media Art as your academic program of interest below if you are interested in

Select Studio Arts as your academic program of interest below if you are interested in

Please select an academic program of interest.

Please provide parent/guardian information for communication purposes.

Parent/Guardian Email Address

Relationship:

Parent/Guardian First Name

Parent/Guardian Last Name

How many guests will be attending with you, including yourself? (Limit: 5)

Will you or a guest require wheel chair access, American Sign Language (ASL), interpreter, or other accommodations during your visit?

Yes

No

Please explain.

Do you or any of your guests have any dietary restrictions?

Yes

No

Please explain.