Prospect Information Form

Prospect Information Form

Please enter the requested information.

- indicates a required field.

Primary Address
Valid From:	Month Day Year (YYYY)
Until:	Month Day Year (YYYY)
Address Line 1:
Address Line 2:
Address Line 3:
City:
State or Province:
ZIP or Postal Code:
County:
Nation:
Phone Number:	- (xxxxxx)-(xxxxxxxxxxxx) (xxxxxxxxxx extension)
International Access Code:

E-Mail Address
E-mail Address:
Verify E-mail Address:

Please indicate the term in which you plan to enroll in college.

Prospect Entry Term
Term of Entry:

If your high school is not listed in the High School Code Lookup, please enter 777777 for your high school code.

If you have taken either the ACT or SAT, please indicate test taken and score received (NOTE: SAT combined equals verbal plus math).

Prospect Birthdate
Date of Birth:	Month Day Year (YYYY)

Prospect Gender
Gender:	Male	Female	Not Specified

Prospect Ethnicity/Race
Ethnicity:

What is your ethnicity?

HispanicNot Hispanic

Hispanic or Latino
Not Hispanic or Latino

Hispanic or Latino

Not Hispanic or Latino

Select one or more races to indicate what you consider yourself to be.

American Indian or Alaska Native	Asian	Black or African American	Native Hawaiian or Other Pacific Islander	White
American Indian or Alaska Native	Asian	Black or African American	Native Hawaiian or Other Pacific Islander	White

Prospect Major
Major:

Please select up to 3 activitives from the list below. To select multiple activities use Ctrl+Click for PC and Command+Click for Mac.

Prospect Interests
Interests:

Release: 8.7.2.12