Open House Registration

Event Attending:

October 5

October 26

November 16

Number of people attending:

First Name:

Middle Initial:

Last Name:

Address:

Please be sure to include city, state and zip.

Phone:

E-mail address we can send your confirmation/directions to:

Alternate E-mail:

Date of birth:

Gender:

Male

Female

Year:

Freshman

Transfer

Name of High school/College:

Graduation Date:

Semester of entry to SUNY Potsdam:

Fall

Spring

Year of entry:

Major: