Undergraduate Information Request

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For information about graduate admission, visit the Graduate School website.

* Contact Information

*First Name:
*Last Name:

* Street Address and Zip Code Use the Alternative Address Form for Apple/Safari users, international address or address that does not exist in the USPS database.

Street Address Line 1: Street Address Line 2:

City: State: Zip/Postal Code: Country:

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Phone, Email and IM Address

Telephone Number:	- -
Email Address:
IM Address:

Personal Information * Gender:

* Date of Birth: Month Day Year

* Citizenship (select one) I am a U.S. citizen or permanent resident
I am a non-U.S. citizen.

* Classification (select one) New Freshman
Transfer Graduation Year:

Educational Background

High School/College Name:
City:
State:
6-Digit School Code:
* Graduation Class (Year):
Overall High School GPA:

Program of Study Select your program of study:

Ethnicity - Mark all that apply Disclosure is voluntary and will not be used in a discriminatory manner
American Indian or Alaskan Native
Anglo, Caucasian, White, not of Hispanic Origin
Asian, Japanese, Chinese, Vietnamese, Korean, Filipino
Black, African American, not of Hispanic Origin
Hispanic, Chicano, Cuban, Puerto Rican, Latino, Mexican American
Native Hawaiian or other Pacific Islander
I do not wish to provide this information

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