Pathways to Academic Success - College Tour 2020 Registration


Required Parent Information (Primary Contact)
     First Name   
     Last Name   
     Address           (Number and Street [or P.O. Box])
     City             
     State            
     Zip Code      
     Primary Phone Number         ()   -         
     Emergency Phone Number    ()   -         
     Do you authorize us to take and post pictures on our website of your student(s) while on the tour?      Yes      No

Optional Parent Information
     Primary Email Address                 (Please provide if available)
     Alternate Email Address             
     First Name (Alternate Contact)   
     Last Name (Alternate Contact)   
     Alternate Phone Number           ()   -