Physics Student for a Day Form

First, Last Name:
E-mail address
Parent(s)/Guardian Name

Street Address
City, State, Zip
Day you would attend
(8:30 AM - 5:30 PM):
 Apr 10, 2017 (Mon)
 Apr 12, 2017 (Wed)
 Apr 17, 2017 (Mon)
 Apr 21, 2017 (Fri)
 Oct 06, 2017 (Fri)
 Oct 09, 2017 (Mon)
 Nov 10, 2017 (Fri)
 Nov 13, 2017 (Mon)
High School
High School Graduation Date
(Month, Year)
Physics teacher's name
Guidance Counselor's name
What term will you first enroll as a student at Virginia Tech? FALL   SPRING   SUMMER
Which program are you interested in?  Bachelor of Science in Physics
 Bachelor of Arts in Physics
 Bachelor of Arts with Teacher Education Option
 Bachelor of Arts Pre Health Option
 Bachelor of Arts Pre Law Option
 Astronomy Minor [more info]
Would you like to attend an Honors College information session?  Yes
Other Comments/Questions:


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Virginia Polytechnic Institute & State University 
Department of Physics MC 0435, 850 West Campus Drive, Blacksburg, VA 24061 
Phone: (540) 231-6544; Fax: (540) 231-7511