| First |
|
| Middle |
|
| Last |
|
| Social Security Number |
|
| Address 1 |
|
| Address 2 |
|
| City |
|
| State |
|
| Zip |
|
| Phone Number |
|
| Email |
|
| Gender |
|
| Date of Birth |
|
| Do you want to live on campus? |
|
If "Yes" you will be billed for housing
and the information will be forwarded
to the housing office. |
|
| College Presently Attending |
|
| Ethnic Group |
|
Check all that apply: |
|
Complete Course Preference
(Maximum enrollment is two courses per summer term.) |
|
| Please refer to the Summer Course Schedule to select courses. |
| |
First Term Choice 1
First Term Choice 2
Second Term Choice 1
Second Term Choice 2
|
| |
|
| |
|