Mansfield (Sayre Campus) Health Sciences Open House

Student Information

First Name

Preferred Name

Last Name

Birthdate

Email Address

Permanent 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

Mansfield

Anticipated Start Term

Bloomsburg Program of Interest

Lock Haven Program of Interest

Mansfield Program of Interest

Mansfield (Sayre) Program of Interest

Visit Details

Number of people attending (including the student)

Parent First Name

Parent Last Name

Parent Relationship

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 any needed accommodations: