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Discovery Day Participant Request Form

Thank you for your interest in UMMC’s Discovery Day!

Please visit the UMMC Prospective Students website for additional information regarding UMMC’s schools, academic programs, and educational opportunities.

To ensure that this event is most effective for the students and chaperones attending, we ask that you read and agree to the following statements.

If my group is selected to participate in UMMC’s Discovery Day, I agree to arrange for one (1) adult chaperone (e.g., teacher, administrator, or parent/guardian) to attend for every fifteen (15) students. *

I agree

I DO NOT agree

I understand that each chaperone will be responsible for accompanying and supervising their student group for the duration of the UMMC’s Discovery Day event. *

I agree

I DO NOT agree

If my group is selected to participate in a Discovery Day event, I agree to arrange for transportation that will ensure our arrival to and departure from the Norman C. Nelson Student Union on the UMMC campus by the event times listed on the itinerary. *

I agree

I DO NOT agree

Contact Information

School name, City, State *

Primary contact person (first, last)/Role *

Primary contact email address *

Primary contact phone *

Secondary contact person (first, last)/Role

Secondary contact email address

Select the type of student group that you are requesting to attend *

If Other, please explain:

What grade level are the students in this group? *

10th

11th

12th

Undergraduate

How many students will be in your group attending Discovery Day? *

What type of vehicle will be used to transport students to the UMMC Jackson campus?

How many vehicles will be used to transport the students to the UMMC Jackson campus?

Do any students need special accommodations while on the UMMC Jackson campus? If so, please list accommodations.

Please rank the date options below in the order in which your group could attend. If your group is selected to attend, the arrival time will be 9:30 a.m. CST, and the event will conclude at 11:30 a.m. CST.

Thursday, October 10, 2024 *

Thursday, November 7, 2024 *

Friday, February 7, 2025 *

Friday, March 21, 2025 *

Friday, April 11, 2025 *

Thank you... The form has been submitted.