2010 Summer Orientation Registration

Please take a moment to complete the following RSVP form. Carefully review each question. While the information is optional, the data will be used to help us more accurately meet your needs during orientation. It is imperative however, that we confirm your attendance by returning this form.

If you need additional information, contact:
orientation@mountainstate.edu
304.929.1402
800.766.6067, x1402

Red text Indicates required fields.

First Name:

Middle Name:

Last Name:

Street Address:

City:

State:

Zip:

Phone:

xxx.xxx.xxxx

E-mail Address:

Do you have a handicap or disability?

Yes No

If yes, will you require special assistance?

Yes No

Name of High School:

Number of guests attending with you:

Are you a transfer
student?

Yes No

If yes:

Name of Institution:

Number of Credits:

Do you plan to live on campus?

Yes No

Have you taken the
following placement
exams?

SAT

Date:	Math:
Composite:	English:

ACT

Date:	Math:
Composite:	English:

I would like to take the Placement exam during Orientation

Have you applied
for financial aid?

Yes No

I plan to enroll:

Part-time (Less than 12 credit hours)
Full-time (12 credit hours or greater)

I plan to take
the majority of
my classes:

Day
Evening
Distance Education/Independent Study

What is your
anticipated major?

Select the Orientation
Date that you plan
to attend:

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