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Fields
Mercy College Visitor Information Log
Name of Requestor
*
First Name
*
Last Name
*
Requestor Department
*
Visitor/Guest Information
Name of Visitor
*
First Name
*
Last Name
*
Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands (US)
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces (the) Americas
Armed Forces Europe
Armed Forces Pacific
Army Post Office (U.S. Army and U.S. Air Force)
Fleet Post Office (U.S. Navy and U.S. Marine Corps)
State
ZIP Code
How many additional guests are in your group?
0
1
2
3
4
5
6
7
Guest 1
First Name
Last Name
Guest 2
First Name
Last Name
Guest 3
First Name
Last Name
Guest 4
First Name
Last Name
Guest 5
First Name
Last Name
Guest 6
First Name
Last Name
Guest 7
First Name
Last Name
Phone
*
Email
*
Date of Visit
*
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Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2024
2025
Time of Visit
*
Hour
01
02
03
04
05
06
07
08
09
10
11
12
Minute
:
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
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28
29
30
31
32
33
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35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
AM/PM
AM
PM
Location Visiting
*
Dobbs Ferry
Bronx
Manhattan
Yorktown
Tarrytown
Affiliation
*
Prospective Student/Family
Current Student
Current Family
Alumni
Guest Speaker
Board Member
Other
Other:
Building Visiting/Room Visiting
*
Reason for Visit or Meeting
*
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