Admissions Programs Registration

Registration

Please complete and submit the form below to participate in one of the many Admissions programs that Mesa State College has to offer. The cost of $15.00 per program includes meals and materials and is nonrefundable. Your family can join you for an additional $6.00 per family member. Payment is due when you arrive to your selected program. Please register at least one week prior to the program.

Check the Date(s) attending:
Program		Dates
	Mesa Madness	Watch for new dates!

Number of students attending program x $15.00 = Student Registration fee*.
*Non-refundable registration fee includes meals and materials.
Add $6.00 for each family member attending lunch x $6.00 =
Total number of people attending. (Payment is due on arrival.)

First Name M.I.
Last Name
Mailing Address
City State Zip
Phone Number Cell Phone Number May we text you? Yes No
Fax Number
Email Address
High School/College
Graduation Year GPA ACT/SAT Score
Academic Major
Ethnic Background (optional)