Accepted students near the Peoria, IL and Quad Cities Area – Sign up for this FREE opportunity to live the life of a Duhawk for a day. We will pick you up December 2 and take you back December 3. Hurry, bus seats are limited!

Peoria - Bus Pickup Date/Time: December 2, 2012, 12:30pm - 1pm

Davenport - Bus Pickup Date/Time: December 2, 2012, 2:45pm - 3pm

Please Choose a Pick Up Location:	Northwoods Mall (in front of Macy’s in Peoria, IL) Hy-Vee Grocery (53rd St. and Utica Ridge in Davenport, IA)
Gender (optional):
Name (First, Middle, Last):
Home Address:
City, State, Zip Code:
Date of Birth:
Home Phone Number:
Cell Phone Number:
E-mail Address:
High School:
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Major(s) of Interest:
Optional: List any Academic Department/Faculty that You Would Like to Meet with.:
Collegiate Athletics of Interest:
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