Yavapai College :

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* Required Fields Thank you for your interest in Yavapai College! Please complete the form below to register for a Discover Yavapai program.
1. Student Information
Last Name *
First Name *
Home Phone Please include area code: xxx-xxx-xxxx
Cell Phone Please include area code: xxx-xxx-xxxx
Address *
Address 2
City *
State *
Zip Code *
Email Address
2. High School Information / Academic Interests
Name of High School Attending*
High School State
Graduation Year *
Primary Academic Interest
Secondary Academic Interest
3. Program Session
Desired Session Date * The November 12 program will be held in the Community Room in the Library, Bldg 19-147. *The November 6 program is for students interested in automotive, mining, or welding only. This event will be held at the CTEC Campus in Prescott, 220 Ruger Road.
Number of Persons Attending (including you)
Names of Parents / Guests Attending
4. High School Counselors Only To register a group of students from your school for a Discover Yavapai program, please complete this section
High School
Counselor Name
Counselor Phone
Counselor Cell Phone
Counselor Email
Desired Session Date - Primary The November 12 program will be held in the Community Room in the Library, Bldg 19-147. *The November 6 program is for students interested in automotive, mining, or welding only. This event will be held at the CTEC Campus in Prescott, 220 Ruger Road.
Desired Session Date - Secondary
Total number of persons attending (Maximum capacity: 50)
Names of Chaperones

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