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Information Please enter the requested information. Please note that an asterisk denotes required information.

Required - indicates a required field.
Prospect Name
Prefix:
First Name: Required
Middle Name:
Last Name: Required
Suffix:
Nickname:

Information Please enter your permanent residence address:

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

Information Please enter a contact email address:

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

Information Please enter your date of birth:

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

Information Please indicate your gender:

Prospect Gender
Gender: Male Female Not Specified

Information Please indicate your citizenship status:

Prospect Citizenship
Citizenship:

Information This is sample Information text for the ETHNICITY section. Modify or delete this text by choosing the Customize a Set of Information Text option on the Web Tailor Administration menu and selecting the bwskwpro.P_WebProspectMain procedure.

Prospect Ethnicity/Race
Ethnicity:

Note What is your ethnicity?

Hispanic or Latino
Not Hispanic or Latino

Note 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 Alaskan Native
American Indian or Alaskan native
Asian
Chinese
Filipino
Indian
Black or African American
Maori
Native American or Other Pacific Islander
White

Information This is sample Information text for the HIGHSCHOOL section. Modify or delete this text by choosing the Customize a Set of Information Text option on the Web Tailor Administration menu and selecting the bwskwpro.P_WebProspectMain procedure.

Prospect High School
Home Schooled (check for yes):
OR
High School Code:
High School Name:
Address Line 1:
Address Line 2:
Address Line 3:
City:
State or Province:
ZIP or Postal Code:
Nation:
Graduation Date: Month Day Year (YYYY)
Class Rank and Size: / (must be numeric)
GPA: (example: 9.99, or A+)

Information This is sample Information text for the TESTSCORES section. Modify or delete this text by choosing the Customize a Set of Information Text option on the Web Tailor Administration menu and selecting the bwskwpro.P_WebProspectMain procedure.

Prospect Test Scores
Test Type: Test Score: Test Date:
Month Year (YYYY)  
Month Year (YYYY)  
Month Year (YYYY)  
Month Year (YYYY)  
Month Year (YYYY)  
Month Year (YYYY)  
Month Year (YYYY)  
Month Year (YYYY)  

Information Please indicate the term in which you would like to apply for:

Prospect Entry Term
Term of Entry:

Prospect Major (Interest area)
Major:

Information Please indicate your areas of interest:

Prospect Interests
Interests:

Information How did you learn about our institution:

How Prospect Learned About Us
How I Learned About Ellucian:

Requested Material
Request Materials:

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Release: 8.7.2.12