Prospective Undergraduate Student - Visit to Neuroscience Department Request

Your Name

Your email address:

A phone number where you can be reached during the day:

Will you be an honor student at the University of Arizona?

Yes

Name of the high school you are currently attending:

If not in Arizona, where is your high school located?

Are you a junior or a senior

Junior

Senior

Date & time you wish to schedule your visit:

Date & time you wish to schedule your visit: : Month

Date & time you wish to schedule your visit: : Day

Date & time you wish to schedule your visit: : Hour

Date & time you wish to schedule your visit: : Minute

Date & time you wish to schedule your visit: : AM/PM

Please indicate an alternate date and time for your visit:

Please indicate an alternate date and time for your visit: : Month

Please indicate an alternate date and time for your visit: : Day

Please indicate an alternate date and time for your visit: : Hour

Please indicate an alternate date and time for your visit: : Minute

Please indicate an alternate date and time for your visit: : AM/PM

Is your start time flexible?

Yes

Special requests: