Consortium Student Event: Riverside, CA

Required fields are marked with an asterisk (*)

*Who is filling out this form?

High School Counselors and School Officials:
You are welcome to attend this program. Please register by completing the fields below. If you are inviting students to participate with you, we request that you ask each student to register individually.

*First/Given Name

*Last/Family Name

*Email Address

*High School or Organization Name
Enter your school's name or CEEB code. Then, select your school from the resulting list. If your school is not listed, please type in the name of your school or organization.

School Code

*Position Title

⚠️ If you are completing this form on behalf of a prospective student, please remember to enter the student's information, not your own.

*First/Given Name

Middle Name

*Last/Family Name

Suffix

Preferred First Name, if different from your first name above

*Birthdate

*Email Address

*Confirm Email Address

*Mailing Address

Country

Street

City

Region

Postal Code

*Phone

*Student Type

*Enrollment Year

*Number of Guests (not including the student)

*Parent/Guardian 1 Email

Parent/Guardian 2 Email

*High School or College Name
Enter your school's name or CEEB code. Then, select your school from the resulting list. If you are home schooled or your school is not listed, please enter six zeros (000000) in this field. (School address is auto-populated below for your reference.)

CEEB Code

School Address

Country

Street

City

Region

Postal Code

*Will you or a family member require wheelchair access or American Sign Language (ASL) interpretation during the program?

*Please explain:

The following questions are optional.

Gender

Citizenship

How would you describe yourself?
Check all that apply:

Please elaborate:

Please indicate the other area(s) of study in which you have an interest: