Elevation of Excellence HBCU College Tour 2024

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March 23 - 30, 2024

Students Name
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Students email address
*

Students phone number
*

Students Home Address
*

Parent/ Guardian Name
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Parent/Guardian email address

Parents phone number

Parent/Guardian Home Address (if different from student)

Student's Date of Birth
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YYYY

School Currently Attending (2023-2024)
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Student's Grade Level (2023-2024)
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What is your current GPA

Please enter your School ID#

What Major are you interested in pursuing

Does your student have any medical conditions or disabilities that we need to be made aware of for this tour?
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Yes

If you answered "Yes" to the previous question, please list any current medical conditions or disabilities

Of the schools listed on the tour, which are your top 3 schools of interest?

Clark Atlanta University

Morehouse College

Spelman College

Morris Brown College

Miles College

Alabama State University

Dillard University

Of the schools listed on the tour, which are your top 3 schools of interest?

Xavier University

Southern University

Grambling State University

Jackson State University

In case of medical emergency, please list your insurance and member ID#

What is your t-shirt size?

Do you have your deposit of $250 secured to pay today?

Yes

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