Midsemester Form

Please note, an asterisk (*) denotes a required question.

Basic Information

First Name*

Last Name*

Preferred First Name

Birthdate*

Sex*

Female

Male

X

Prefer Not to Respond

Contact Information

Email Address*

Cell Phone Number

Mailing Address*

Country

Street

City

Region

Postal Code

Enrollment Information

For Student Type:

Choose 1st year if you have not been enrolled at a college or university since graduating from high school.
Choose transfer if you have been enrolled at a college or university since graduating from high school.

Student Type*

1st Year

Transfer

Primary Academic Interest*

Secondary Academic Interest

Educational Information

High School

College Currently Attending/Most Recently Attended

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