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Marian University

San Damiano Scholar Preview Day Registration

* denotes required fields

Part One - Personal Information
Personal information is never shared with groups not associated with Marian University. Review our privacy policy for more information.

*First Name:  
*Last Name:  
Middle Name
*E-Mail Address:  

*Address  

*City  

*State

*Zip  

*Home Telephone
(include area code)  
*Cell Phone
(include area code)  
*Can you receive text messages? Yes    No   
*May we send you text messages related to the San Damiano Scholars Program? Yes    No   
Gender
Date of Birth
*Number of Persons Attending.
(excluding yourself)
*Names of Persons Attending
(Mom, Dad, Siblings, etc.)
*T-Shirt Size
*Please list any food allergies.

Part Two - High School Information
High School:
Address:
City:
State
Zip
Guidance Counselor
Graduation Year

Part Three - Religious Information
Parish or Congregation Name
Address
City
State
Zip
Pastor’s Name
Youth Minister's Name
Diocese

Part Four - Enrollment Information

*Intended Major

Extracurricular Interests




















Minor(s)
Requested Date of Enrollment