Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

Email Address *

Major *

Additional Major (if applicable)

Minor

Additional Minor (if applicable)

Have you visited the campus? *

Please list any clubs or organizations you were involved in while in high school:

Do you have any physical accessibility needs that we could accommodate for your participation in the Bridges Program? If so, please explain. All of our outdoor activities will be challenges by choice.

Please list any food allergies that you might have. The group will eat off campus on some occasions during the duration of the Bridges Program.

Drury Bridges Application