Information Request Form

First Name

Middle Name

Last Name

Date of Birth

Gender

Email Address

Mailing Address

Country

Street

City

Region

Postal Code

Academic Information

Major of Interest

Enrollment Category

Freshman

Transfer

Other

*Transfer student: 12 or more semester credits earned after high school graduation.

High School Information

School Name

School CEEB Code

Graduation Year

College Information

Last Institution Attended

School CEEB Code

Start Date

End Date

Total Number of Credit Hours Expected

Parent/Legal Guardian Information

Relationship Type

Parent/Legal Guardian First Name*

Parent/Legal Guardian Last Name*

Parent/Legal Guardian Email Address*

Parent/Legal Guardian Information

Relationship Type

Parent/Legal Guardian First Name

Parent/Legal Guardian Last Name

Parent/Legal Guardian Email Address