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General Information Request Form


Complete all parts of this form and click on the send button below.

Name

Address

City
, ST Zip
Country

Phone

Email

Gender Male Female

Birthdate (MM/DD/YY)

Year of high school graduation

Name of high school

Name of college

Athletic Interests
(Select all that apply.)
Academic Interests
(Select all that apply.)

Intercollegiate:
Baseball (Men)
Basketball (Men)
Basketball (Women)
Cross Country (Men)
Cross Country (Women)
Football (Men)
Soccer (Men)
Soccer (Women)
Softball (Women)
Tennis (Men)
Tennis (Women)
Track & Field (Men)
Track & Field (Women)
Volleyball (Women)

Club:
Cheerleading (Men & Women)

Art
Biology
Business
(Accounting, Administration, Management, Marketing)
Chemistry
Communication
(Broadcasting/Mass Communication, Public Relations, Theatre)
Computer Science
Digital Media
Education
(Elementary, Secondary, Music, Physical Education, Special Education)
English
History/Political Science
MIS
(Management Information Systems)
Mathematics
Ministry
(Pastoral, Urban Cross-Cultural, Youth)
Modern Languages
(French, Spanish)
Music
(CCM, Pedagogy & Literature)
Philosophy
Physics
Psychology
Recreation
Religion
Social Work/Sociology

 

I attend church Yes No
If yes, name of church

Church Denomination

Semester I plan to begin college
Fall Interterm Spring Summer
of which year

Additional comments or questions

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(618) 664-6622 ~ (800) 345-4440
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