1. I would like to attend Personalized Campus Visit on:

   • Enter Date:
2. Full Name
3. Street Address
4. City
5. StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
6. Zip/Postal Code
7. Telephone (XXX-XXX-XXXX)
8. E-mail
9. Intended Major
10. Current year in school
11. Current High School
12. If someone in your party will need special assistance, please explain

Sauk Valley Community College requests this information for the purpose of mailing you information and to create a record of your interest. No persons outside the college are provided this information.