Academic Department Visit Request

Student Information:

Student First Name*

Do you have a preferred first name (different from your legal name) that you would like to provide us?*

Yes

No

Note: UofL uses preferred name in communications to you via text, email and in print mailed to your address. We also use it when communicating with parents/guardians. If you are not comfortable having some people know this first name, you do not need to share it at this time.

Student Preferred Name*

Student Last Name*

Student Preferred Pronouns

he/him/his

she/her/hers

they/them/theirs

other

Pronouns (Other):

Student Birthdate*

Student Email Address*

Student Mobile Number*

Academic Information

High School*
Please type your school name, then scroll and SELECT your school from the drop down to ensure a match with our records. Typing in a city or abbreviated state (ex: Sacred Heart KY) can also help narrow your search.

CEEB Code*

School Level of Study*

College Level

High School Level (only report school you are graduating from)

Anticipated Start Term*

Intended Major*

Is the major you selected above the department you would like to visit?

Yes.

Actually, I would like to visit a different department.

Which department would you like to visit?

Registration Details

Total Attendees Registering*
The total number of attendees includes the student and a maximum of 2 guests.

Guest Email Address

Do you or your guest(s) require any special accommodations to participate in this event (ASL interpretation, language or physical accommodations, etc.)? Language/ASL interpretation requests, must be made at least 2 weeks in advance of the visit. Mobility/golf cart requests must be made at least 5-7 business days in advance of the visit.

Yes

No

Please describe your accommodation needs in detail: