Pre-Med & Nursing

Student Name and Contact Information

Preferred Name

First Name

Last Name

Email Address

Student Cell Number

Mailing Address

Country

Street

City

Region

Postal Code

Do you have a parent, grandparent, sibling, or other family member that has attended Drury University? If so please check the "Legacy" box below.

Yes

No

Name and relationship of Drury Alum

Would you like to provide contact information for parent/legal guardian?*

Yes

No

Parent/Guardian Relationship*

Parent/Guardian First Name*

Parent/Guardian Last Name*

Parent/Guardian Email*

Academic Information

What school do you currently attend?*
(If your school is not listed please select unknown.)

Hidden Field: CEEB Code

Hidden Field: Level of Study

Year of High School Graduation*

Anticipated Start Term*

Student Type*

Anticipated Major/Program*

Which areas of study and/or activities would you like to learn more about during your visit? Choose all that apply.

Additional Options

Would you like to receive free tickets to attend Drury’s Musical Performance of “Into the Woods” on Friday, November 17th, at 7:30pm?

Yes

No

If yes, how many?

Are you actively being recruited by a Drury Coach?

Yes

No, however I am interested in playing a sport at Drury.

If yes, what sport?

How many guests do you plan to bring with you?

Additional Comments: (Please include any dietary restrictions, mobility concerns, health issues, or other considerations for your visit.)