Bloomsburg Open House

Student Information

First Name

Preferred Name

Last Name

Birthdate

Email Address

Mailing Address

Country

Street

City

Region

Postal Code

Mobile Phone

Can we text you important updates from Commonwealth University?

Yes

No

T-shirt Size (unisex)

Current School or University:

School CEEB Code

Program Information

Anticipated Student Type

Please select the campus(es) that you are interested in learning more about

Bloomsburg

Lock Haven- Main

Mansfield

Lock Haven- Clearfield

Anticipated Start Term

Program of Interest

This selection is available on the Bloomsburg Campus.

This selection is available on the Lock Haven Campus.

This selection is available on the Mansfield Campus.

Program of Interest

Visit Details

Number of people attending (including the student)

Parent First Name

Parent Last Name

Parent Email

Do you have needed accommodations that we can prepare for? (example: dietary restrictions, accessibility concerns, etc)

Note on dining: A variety of dining options will be available in our buffet - a nutritionist will be on staff for specific questions during the event.

Yes

No

Please describe needed accommodations: