Request for Information

Student's First Name

Student's Last Name

Student's Preferred First Name (the name we'll use in our emails and mailings to you)

Student's Email Address

Student's Mobile Phone

Student's Twitter Handle (Used for DMs and/or Twitter mentions. Won't be used to review your social media.)

Would you like to include a parent's email or phone number as a back-up contact?

Yes

No

Parent's First Name

Parent's Last Name

Parent's Relationship

Parent's Email Address [INACTIVE]

Parent's Email Address

Parent's Preferred Phone

Student's Birthdate

Student's Address

Country
Street
City
Region
Postal Code

What admissions unit or outreach center are you interested in?

What academic level are you interested in?

Which of these best describes you?

In which term would you like to enroll?

Current/Former High School

CEEB Code

Current/Former College

CEEB Code

Current Number of Credits

Academic Interests

I am still deciding

Business

Are there specific pieces of information you're looking for or specific questions you'd like answered? If so, let us know.

Prospecting Unit EUG

Prospecting Unit GCE

Prospecting Unit MNE

Prospecing Unit BTW

Prospecting Unit COR

Mercyhurst University