Request for Information

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Personal Information

First Name*

Last Name*

Preferred First Name

Birthdate*

Gender*

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Email Address*

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Please select the statement that reflects your current status:*

What year will you graduate high school?

Semester You Plan to Enroll:*

What is the name of the high school you currently attend:*

School CEEB Code (This will be filled based upon the school name you entered. If this box is not filled then type the name of your school again and select from the list provided. If your school is not listed then type and select: My School is Not Listed Domestic.):*

What is the name of the college or university that you last attended? If you have not attend a college or univeristy after graduating high school then list the high school where you graduated:

School CEEB Code (This will be filled based upon the school name you entered. If this box is not filled then type the name of your school again and select from the list provided. If your school is not listed then type and select: My School is Not Listed Domestic.):*

My primary academic interest is:

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