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Address *

City *

State *

Zip/Postal Code *

County

Country *

Basic Information Who are you

Email *

If you do not have an email, contact 419-783-2359 to set up your visit.

First Name *

Last Name *

Address Line 1 *

Address Line 2

Zip/Postal Code *

County *

Sex *

High School Graduation Year *

High School *

If you cannot find your high school name, add 000000 and you will have the option to say my school is not listed.

Entry Year *

Year you will Enter College

Student Type *

Primary Phone *

Primary Phone Country Code

Would you like to have an academic meeting during your visit? *

This is typically a meeting with a Defiance College faculty member; In the event that there is no faculty member available, a staff member will meet with you.

Interests Tell us about yourself

Major *

Primary Activity *

Are you being recruited by a DC coach? *

Recruiting Coach

Activities Interest

Arts Programs

Do you have any visit requests?

e.g. Is there someone in particular you'd like to meet with?

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