Focus Days: Education and Health

Your Contact Information

*Indicates a required field.

*Email Address

*First Name

Middle Name

*Last Name

*Birthdate

Phone Number

*Mailing Address

Country

Street

City

Region

Postal Code

Parent/Guardian Contact Information

We plan to send university specific information that is directly related to your student to the parent/guardian email address provided. If you wish to receive this information, please check the 'Yes" box below.

Yes

Please select your parent or guardian type:

First Name:

Last Name:

Email Address:

Primary Phone Number:

Is this mailing address different than the student's mailing address?

Yes

No

Mailing Address:

Country

Street

City

Region

Postal Code

Is your parent/guardian an Arkansas Tech University alumni?

Yes

No

What is their year of graduation? (You can leave blank if you are unsure)

Your Academic Information

*Which high school are you currently attending?

*Expected High School Graduation Date

When do you plan to start taking classes at Arkansas Tech?

*What do you want to study at Arkansas Tech? (If you're undecided, select "General Education.")

Additional Details

*How many guests will be with you? (Parents, guardians, relatives, etc.)
Additional student participants should complete a separate registration.

Do you have an accessibility need?

Yes

No

Can you please provide a brief description of your accessibility needs? This will help us better prepare for your arrival.