MESA Enrollment Form 2026-2027

MESA 2026-2027

Student Enrollment Form
Welcome to MESA!

An enrollment form is required for any student participating in MESA. A completed enrollment for is required for any student to attend MESA Day on May 21st, 2027. Please reach out to your MESA Chapter Advisor or ormesa@pdx.edu if you have any questions!
Student Information
Legal Name (first and last name)
(Ex: Julio Martinez)
Preferred Name or Nickname
(Ex: Julio)
26-27: Preferred Pronouns (select all that apply)

Other
26-27: Gender
Date of Birth

MonthDayYear
Oregon Student ID Number
If unknown, please ask your teacher as it is required or put 0
26-27: Student Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
26-27: Student Email
example@example.com
26-27: Household Zip Code
26-27: T-Shirt Size
Note that these are adult sizes, not youth.
26-27: Current Grade
26-27: Anticipated High School Graduation Year
26-27: MESA Chapter
This is your school or club's name.
26-27: What year did you join MESA?
(Ex: 2026)
26-27: Race/Ethnicity (select all that apply)

Other
26-27: What would you like to study in college?

Other
26-27: Do you have any Allergies/Dietary Restrictions?
26-27: Do you have any accommodation/accessibility needs?
Do you require any accommodation, mobility or translation assistance to participate in MESA Events outside of chapter meetings? If yes, please specify what those are.
Should be Empty:

MESA 2026-2027