Request for Information

About You

What type of student are you?

First Name

Preferred First Name

Last Name

T-Shirt Size

Birthdate

Contact Information

Preferred Email Address

We recommend using a standard email provider for your preferred email address such as gmail or yahoo. Email addresses assigned by your high school may filter messages sent from Oregon Tech.

Home Phone Number

Cell Phone Number

I give permission to Oregon Tech to send me important updates via text messaging.

Yes

Mailing Address

Country
Street
City
Region
Postal Code

Do you physically live at the above address?

Home Address

Country
Street
City
Region
Postal Code

Would you like to receive a viewbook?

Yes

Do you want your parent/legal guardian to receive information?

Parent / Guardian Information

Parent/Legal Guardian First Name

Parent/Legal Guardian Last Name

Parent/Legal Guardian Phone

Parent/Legal Guardian Email

Parent/Legal Guardian Address

Country
Street
City
Region
Postal Code

Relationship

Are you the Parent/Legal Guardian filling out this form? It's ok, be honest :)

Yes