FIRST NAME
LAST NAME
EMAIL
DATE OF BIRTH
PHONE NUMBER
STREET ADDRESS
CITY
STATE
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AL
AK
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
ZIP
WHAT IS YOUR CITIZENSHIP STATUS?
INTENDED ENTRY SEMESTER
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Fall
Spring
Summer
INTENDED ENTRY YEAR
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2024
2025
2026
I PLAN TO ENROLL AS
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First-time Freshman
Transfer
Dual Enrollment
Graduate
Guest Student- Transfer
Non-Degree Seeking Undergraduate
Non-Degree Seeking Reentry
INTENDED PROGRAM OF STUDY
Contact Information