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Prospect Information Form

  

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Information  Please enter the requested information.

Required - indicates a required field.
College Entry Term
Term of Entry:Required

Name
Prefix:
First Name: Required
Middle Name:
Last Name: Required
Suffix:
Nickname:

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:

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

Gender
Gender: Male Female Not Specified

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

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 Native Alaskan
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
Caucasian or White

Prior College(s) Attended
College Code:
Prior College Name:
Address Line 1:
Address Line 2:
Address Line 3:
City:
State or Province:
ZIP or Postal Code:
Nation:
Attended From:
Attended To:
Graduation Date: Month Day Year (YYYY)
GPA: (example: 9.99)
Degree:

Information Enter your intended area of study.

Intended College Major
Major:

Interests
Interests:

How You Learned About AU
How I Learned About Auburn University:

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Release: 8.7.2.12