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Lindsey Wilson College

 

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Prospect Information Form

  

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Information Please enter your information in the fields below. Please note that an asterisk denotes required information. Please use proper capitalization.

Please do not use the Enter key; use the scroll bar or mouse for navigation.

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

Information Please enter your permanent 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:

Prospect SSN/TIN/TFN
U.S. Social Security Number: (999999999 or 999-99-9999)

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

Prospect Citizenship
Citizenship:

Information Please select your ethnicity.

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
Asian
Black
Native Hawaiian or Other Pacific Islander
Caucasian

Prospect Gender
Gender:Required Male Female Not Specified

You may click on Look Up High School Code for schools in Kentucky. For those outside Kentucky, please enter the school name and the city and state. If you earned your GED, please enter GED as the school name and add your city and state.

Prospect High School
Home Schooled (check for yes):
OR
High School Code:
High School Name:Required
Address Line 1:
Address Line 2:
Address Line 3:
City:Required
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 Please select the term you may attend Lindsey Wilson College.

Prospect Entry Term
Term of Entry:Required

Prospect Major
Major:

To select multiple responses, please press Ctrl and Left Click.

Prospect Interests
Interests:

Information Please enter your preferred email address.

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

To select multiple responses, please press Ctrl and Left Click.

How Prospect Learned About Us
How I Learned About Lindsey Wilson College:

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Release: 8.7.2.12