Rehabilitation Sciences Day

Registration Information

I am registering as a(n):

Individual

School Group

First Name

Last Name

Email Address

Birthdate

Mailing Address

Country

Street

City

Region

Postal Code

Mobile Phone

I would like to receive text messages from Shawnee State University

Yes

No

High School Attended

Graduation Year

Please select any/all of the majors you have interest in

Occupational Therapy Assistant (associate)

Occupational Therapy Bachelor’s to Master’s 3+2

Physical Therapy Assistant (associate)

Criminal Justice

Including yourself, how many will attend? (Required)

School or Organization Name:

Academic Levels:

10th Grade

11th Grade

12th Grade

Check-in will run from 9am - 9:30am with the welcome beginning at 9:30am. What time will your group arrive?

9:00am

9:30am

10:00am

Estimated number of students attending:

Contact Name:

Contact Title:

Contact Phone:

Contact Email:

Please list any accommodations needed: