Prospective Student Information Request Form

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I am interested in a...

I am a prospective...

Are you a current high school student?

High School

Expected Graduation Date:

Most Recent College/University Attended

Please select the program below that most interests you:

Please choose a preferred campus/location:

Do you plan to take undergraduate level courses or graduate level courses?

What year are you planning to start school?

What semester are you interested in?

Student Contact Information

Student Legal First Name

Preferred Name/Nickname

Student Legal Last Name

Birthdate

Email Address

Mobile Phone Number

May we text you?

Yes

No

Current Mailing Address

Country

Street

City

Region

Postal Code

Please select your primary country of citizenship:

Are you a U.S. Permanent Resident?

Yes

No

Please select your U.S. citizenship status:

Please select your current Visa status OR the Visa you intend to pursue:

Please select the program below that most interests you:

Anticipated Year to Start

Starting Semester

Please choose a preferred campus/location:

Questions/Comments: