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Student's First Name

Student's Last Name

Do you have a different first name or nickname that you would prefer we use in our emails and mailings to you?

Student's Preferred First Name or Nickname

Student's Email Address

Student's Mobile Phone

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

Parent's Preferred Phone

Do you reside with this parent?

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

Criminal Justice

Education

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.

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Prospecting Unit GCE

Prospecting Unit MNE

Prospecing Unit BTW

Prospecting Unit COR

Mercyhurst University

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