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Registration Form

Please fill out one registration form per family and list each student attending the event who is a freshman, sophomore, junior or senior in high school for a chance to win a scholarship!

Please complete the registration form as best you can for each student

Fields marked with * are required.

Location*

Person Registering Name* Address City State Zip Phone Email*

Student 1 Information Name Date of Birth
Gender Graduation Year
Current School Current Extracurricular Activities Cumulative GPA ACT/SAT/PSAT Scores
Desired College Desired Major
College Living Arrangements If Other please specify

Student 2 Information Name Date of Birth
Gender Graduation Year
Current School Current Extracurricular Activities Cumulative GPA ACT/SAT/PSAT Scores
Desired College Desired Major
College Living Arrangements If Other please specify

Student 3 Information Name Date of Birth
Gender Graduation Year
Current School Current Extracurricular Activities Cumulative GPA ACT/SAT/PSAT Scores
Desired College Desired Major
College Living Arrangements If Other please specify

Student 4 Information Name Date of Birth
Gender Graduation Year
Current School Current Extracurricular Activities Cumulative GPA ACT/SAT/PSAT Scores
Desired College Desired Major
College Living Arrangements If Other please specify

Attendees Name of additional attendees (not student) Total Number of Attendees

Income

Annual household income*

< $50,0000
$50,000-$100,000
$101,000-$250,000
$251,000-$500,000
> $500,000

For Attendees

Pittsburgh
San Diego

For Businesses

Pittsburgh (pdf)
San Diego (pdf)

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