Request for Information

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Personal Information

First Name*

Middle Name

Last Name*

Preferred First Name

Birthdate*

Gender*

Female

Male

Contact Information

Email Address*

Confirm Email Address*

Mobile Phone Number*

May the Admissions Office contact you via text?*

Yes

No

Alternate Phone Number

Address*

Country
Street
City
Region
Postal Code

Academic Interest

I am considering ETBU as a:*

Intended entry term:*

My primary academic interest is:*

Extracurricular Interests:

School Information

Enter the high school or college you currently attend or most recently attended. (If you are homeschooled, please indicate "homeschool.") *

Current School CEEB Code

Date of intended completion/graduation:*

Additional Information

How did you hear about ETBU?*

Which social networking site?*

Please specify:

What church are you currently attending?

What is your current level of interest in ETBU?*

Additional comments or questions:

1st Origin