Perspectives Day Program

* Required

* First Name

Preferred Name/Nickname

Middle Name

* Last Name

* Email Address

*Cell-phone number

* High School

* Birthdate

* Mailing Address

Country

Street

City

Region

Postal Code

* Sex

Female

Male

Gender Identity (optional)

Gender Identity-other

* Will you attend Perspectives with a guest (parent, sibling, guardian, community mentor, etc)?

Yes

* Total guests attending (not including the student)

* Have you visited Holy Cross before?

Yes

* Will you be the first in your immediate family to attend a four-year institution (not including a sibling)?

Yes

* Do you or anyone in your party require accommodations during your visit (including American Sign Language interpretation, wheelchair access, and/or language translation services including but not limited to Spanish, Portuguese, or Albanian)?

Yes

* Requested accommodations (if language translation services are requested, please include which language is needed).

*Do you have any dietary restrictions or allergies?

Yes

*Dietary Restrictions/Allergies

*Are you in a Community-Based Agency (Upward Bound, A Better Chance, Emerge, etc.)?

Yes

Name of Community-Based Agency

*Co-curricular interests

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Perspectives Day Program