Summer Honors 2003

Student Information Form

(Please Print)

 NAME:_____________________________________________

Address:___________________________________________________

 In case of emergency, please contact:_________________________________________

 Home phone:____________________  Work Phone:______________________

 Please indicate any preexisting medical conditions and/or medications of which we should be aware:

_____________________________________________________________________

 Do you have a roommate preference?__________________________________

 T-Shirt size (circle one):  Medium   Large   X-Large  XX-Large    Other:_________

Travel Information:

How will you be arriving?     CAR       BUS          PLANE

 If you are arriving by PLANE, and will need transportation to campus from the Chattanooga airport please provide the following information:

                                                                 Arrival                 Departure

Airline:_____________________ Flight Number:_____________      ____________

                                    Date &Time: ______________            _____________

 If you are arriving by BUS and need transportation to campus from either the Chattanooga or Cleveland bus station, please provide the following information: (circle one)                   CLEVELAND                      CHATTANOOGA

                               Arrival date& time:_____________________________________

                          Departure date & time:________________________________

 Summer Honors begins Sunday, June 29 and ends Friday, July11. Will you need lodging an additional night? If so please circle the necessary date(s):

Saturday June 28      Saturday July 12