Multicultural Student Bridge Pre-Orientation Program


*First Name: 
*Last Name: 
*Address: 
*City: 
*State:  *Zip: 
*Home Phone: 
*Cell Phone:
*Email Address: 
Major:
Minor:
Housing Classification:
*T-Shirt Size:


What are your interests/hobbies?
In coming to LVC, what are you the most excited about?
What are you concerned about?
Athletic Team:
Will you be on campus early for the following?

Dietary Needs:
If yes, please explain:

Medical/Other Special Needs:
If yes, please explain:


Emergency Contact
Name:
Phone Number: