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Campus Visit Request from Website
*First Name:
*Last Name:

*Date of Birth (mm dd yyyy):
*Street Address:
*Zip Code:
*Cell Phone:
*Cell Phone Carrier:
*May we send you text messages?:

*Home Phone Number:
*Email Address:
*Primary Academic Interest:
*Secondary Academic Interest:
*High School Name:
*Year of High School Graduation:
*Intended Start Date at Crossroads:
*Home Church Name:
*Home Church Denomination:
*Preferred Date for Visit:
*Time Preference for Preferred Date:

*Alternate Date for Visit (in case preferred date is not available):
*Time Preference for Alternate Date:

*During my visit, I would like to:

*Please list the names of any family members or friends who will be visiting with you:
*Please add any comments or special requests:
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(Items marked * are required)

Crossroads College
920 Mayowood Road SW
Rochester, MN 55902, USA
(507) 288-4563 or (800) 456-7651

Copyright 2014 Crossroads College