Outreach & Recruitment
Prospective Student Information
Last Name *
Your answer
First Name: *
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Street Address/Apartment Number: *
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City: *
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State: *
Zip Code: *
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Phone Number: *
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Email: *
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Date of Birth: *
MM
/
DD
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YYYY
Sex: *
High School Graduation Year *
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Name of High School: *
If your high school is not listed, please specify:
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Projected Major: *
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Academic Goal: *
Required
Projected Enrollment Term - Semester, Year: (Ex: Fall 2017) *
Your answer
Support Service Request:
Are you Hispanic or Latino/a? *
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