WIU - QC Saturday Visit Registration
Complete this form to register for one of our upcoming Saturday presentations at our Quad Cities Campus in Moline, Illinois. Additional details will be provided via email. We look forward to having you on campus!
Which Quad Cities presentation would you like to attend?
*
Saturday, October 12 at 9:00 AM
Saturday, November 7 at 9:00 AM
Student Name
*
First Name
Last Name
Student Date of Birth
*
-
Month
-
Day
Year
Date
T-Shirt Size
Small
Medium
Large
X-Large
2XL
3XL
Student Email Address
*
example@example.com
Parent/Guardian/Guest Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Student Type
*
Freshman
Transfer
Most recent high school/ college
*
List the last school you attended
When would you like to start at WIU?
*
Spring 2025 (January)
Summer 2025 (June)
Fall 2025 (August)
Later than Fall 2025
Anticipated Major
*
What are you interested studying at WIU?
Guest Information
Space is a bit limited, but feel free to bring guests with you to your visit
How many guests will be joining you?
*
One guest
Two guests
No guests
Guest One Name
First Name
Last Name
Guest Two Name
First Name
Last Name
Please list any accommodation you or your guest(s) may need to fully participate in this event
(Mobility aids or parking assistance)
Submit
Should be Empty: