Pre-Orientation Registration

Registration closes June 26, 2013

Last Name*
First Name*
Current Address
City
State
Zip Code
Country
Phone Number

Email Address (Penn preferred)*
Parent Email Address

Campus Address (if known)
College House
Building Name
Room Number

Cell Phone Number
Penn ID Number (This is an 8-digit number in bold on your PennCard. You can also find it in your PennKey set up letter, or on CampusExpress if you set up your PennKey. Otherwise leave blank)
T-shirt size - Please note, these are Women's sizes and tend to run small
Major
	Check here if you are in M&T.
	Check here if you are in VIPER.
Race/Ethnicity
	Other:

Please answer all of the following questions.
Please list your activities in high school:

What is one thing you’d like to get out of the AWE pre-orientation program?

Are you applying for other Penn pre-orientation programs? If so, which ones? Please note, applying to other programs will not affect your acceptance into the AWE program but you will only be able to attend one program. Please list your preference of programs.


Are you taking any medication? If yes, please specify:

Are there any medical conditions of which we should be aware? If yes, please specify:

Do you have any food allergies?

Are you vegetarian? Vegan? Kosher?

Is there anything else we should know about you?

I understand the AWE program is scheduled from Tuesday, August 20- Friday, August 23, 2013. The cost of the program is $400.00 which I agree to pay immediately upon receipt of the acceptance packet.* Note: For those students eligible for financial aid through the University of Pennsylvania, limited financial assistance is available. Please indicate if you wish to be considered. Yes, I am eligible for financial aid through Penn and wish to be considered for financial assistance to support my participation in the AWE program. (Any type of financial aid or work-study through the University qualifies). Please submit your application by June 26, 2013. If you have questions, feel free to write Michele Grab.