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Thank you for your interest in W&J! The Office of Admission will be in touch with you shortly to confirm the details of your visit.

1.	First Name*

2.	Last Name *

Gender

	Male
	Female

4.	Street Address*

5.	City*

6.	State*

7.	Zip Code *

8.	Phone Number* (Ex: 555-555-5555)

9.	Email Address*

10.	Please indicate a parent/secondary email you would also like visit confirmation sent to:

11.	High School*

12.	Graduation Year*

13.

Transfer Students

		Are you a tranfer student?		If so, what institution do you currently attend?		If so, what year do you expect to enroll at W&J?
*

14.	How do you prefer we contact you to confirm your visit?*

15.	Requested Date of Visit* (We will contact you via your preferred method to confirm availability on this date and time.)
	mm/dd/yyyy

16.	Requested Time of Visit* (Visits typically last for approximately 2 hours and include a meeting with an Admission Counselor and a student-led walking tour of campus)

17.

Do you wish to include any of the following as part of your visit?
(Subject to availability of particular representatives on your preferred visit date and time.)

	Meeting with an Athletic Coach
	Meeting with a Professor
	Meeting with Financial Aid
	Sit in on a Class
	Spend the Night with a Current Student

Other, please specify

18.	If you selected "Coach" please choose a sport

20.	The Admission House has a one-step entrance. Would you prefer to meet in a wheel-chair accessible location? If so, the Office of Admission will schedule your campus interview in an alternate location.

21.	If you indicated 'yes' above, would you prefer a golf cart tour of campus instead of a walking tour?

22.	Number of people who will be visiting campus (including yourself)*

23.	Additional requests, comments, or questions?