Information Request Form
* Indicates required field

Personal Information

First (Given) Name*
Middle Name
Last (Surname/Primary) Name*
Suffix (Jr, Sr, II, III)


Female Male

Date of Birth* (MM-DD-YYYY) (e.g. 05-30-2003)
Email Address*
Parent 1 Email
Parent 2 Email
Are you a US Citizen
or Permanent Resident?*
Yes No

Contact Information

Country *

Address 1*
Address 2
Address 3
Address 4
State (US)

ZIP/Postal Code
Phone (Home)

Academic Information

Student Type*

Intended Entry Term*

Do you wish to study Full-Time or Part-Time?

Full-Time Part-Time

Are you Deaf or Hard of Hearing?*
Yes No
1st Choice Desired Major: 
2nd Choice Desired Major:
3rd Choice Desired Major: