Virtual Evening with UGA

Student Information

First Name*

Preferred First Name

Middle Name

Last Name*

Suffix

Email Address*

Mobile Phone

Birthdate*

Student Type

Mailing Address*

Country

Street

City

Region

Postal Code

School Information

School Name Search (Name, City, CEEB): Please start typing your school's name and click on the result to populate the address information*
If you are home schooled, enter HS4444, or if your school is not listed, please start by typing "Unknown" in the field below. Please do not abbreviate

School Code (please be sure to fill out the box above to populate this field)

Rising High School Graduation year*

Level of Study

High School

Additional Information

Would you like your parent(s) or guardian(s) to be included on communication about this event? *

Yes

No

Parent or Guardian 1 First Name *

Parent or Guardian 1 Last Name *

Parent or Guardian 1 Email *

Parent or Guardian 1 Phone Number

Parent or Guardian 2 First Name *

Parent or Guardian 2 Last Name *

Parent or Guardian 2 Email *

Parent or Guardian 2 Phone Number

Are you Hispanic or Latino/a/x?

Yes

No

Race

American Indian or Alaska Native

Asian (including the Indian subcontinent)

Black or African American (including Africa and Caribbean)

Native Hawaiian or Other Pacific Islander

White (including Middle Eastern)

Are you a first-generation college student (neither of your parents or legal guardians graduated from a four-year college or university)?

Yes

No

Virtual Evening with UGA

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