Student for a Day Program - Department of History

Title*

Name*

First Last

Email*

Date of Birth*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number*

Do you have any allergies or dietary restrictions?*

Yes
No

This program includes a free lunch in our Residence Cafeteria, who can accommodate for most allergies and dietary needs/restrictions.

Do you have mobility and/or other special physical requirements?*

Yes
No

Are you currently enrolled in High School?*

Yes
No

Expected year/term entry to University*

Example: Fall 2024, Winter 2025 etc.

Estimated Academic Average*

Do you know the exact date(s) and time(s) you would like to request?*

Yes, I know the exact date(s)
No, will provide availability instead

A typical university day could include scheduled coursework between the hours of 8:30am and 5:30pm. Are you requesting specific date(s) and time(s), or would like us to let you know our availability based on days/times provided?

Do you have any specific date or time restrictions?*

Example: only available 9am-12pm, not available Dec 1 etc.

Would you like any of the following to be included in your day?*

Meeting with Professor
History Department Tour
Campus Tour
None of the above

Select all that you would like to be included in your day.

Do you request a student guide of the same gender?*

Yes
No preference

At Carleton University, we recognize and respect the importance of privacy. Personal information that we collect is kept confidential. In accordance with section 41 of the Freedom of Information and Protection of Privacy Act, Carleton University will only use the information in its custody or control in the following circumstances: where the individual identifies the particular information and consents to its use; for the purpose for which it was collected or a consistent purpose (i.e. a purpose which the individual might have reasonably expected). Please read our full Privacy Notice at admissions.carleton.ca/privacy.

How did you hear about this program?*

Carleton Event (Fall Open House, March Break Day etc.)
Google Search
Carleton Website
Word of Mouth (Friend/Family etc.)
High School Visit or Fair
Email
Phone Call
Other

Please select all that apply