2024 Physician Assistant Visit Day

Friday, December 6, 2024 at 9:00 AM until 1:30 PMEastern Standard Time UTC -05:00

Marietta College
215 5th St
Marietta, OH 45750
United States

Additional Notes:

* = Required Field

First Name*

Preferred First Name

Last Name*

Preferred Pronouns

Birthdate*

Email Address*

Sex*

Gender Identity

Parent Email Address

Mailing Address*

Country

Street

City

Region

Postal Code

Student Cellphone (By providing this you are opting IN to receive text messages)

Search for your school*

Entry Term*

Will you be entering as a FRESHMAN or as a TRANSFER?*
(If you have attended college after graduating from high school, you should select transfer)

Primary academic interest*

In which licensure option are you interested?

Secondary academic interest

In which licensure option are you interested?

Sport

T-Shirt Size

Are you a Legacy Student?* (Mother, Father, Grandmother, Grandfather or Step-Parent graduated from Marietta College)

What was their name at the time of graduation, what year did they graduate and what is their relationship to the visiting student?

Number of guests in addition to prospective student (visit groups are limited to a maximum of four people)*

Do you or any person in your party require accommodations due to a disability?*

Please explain: