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EPIC Freshman Questionnaire 2021
Hello Incoming Freshman!
Please answer the following questions so that we can match you up with a mentor in our program.
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Parent Email Address
*
Your answer
Sex
*
Male
Female
Parent Phone Number
*
Your answer
Can this phone number receive text messages?
*
Yes
No
Student Email Address
Your answer
Student Phone Number
Your answer
Can this phone number receive text messages?
Yes
No
Clear selection
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
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