2012-2013 STUDENT DATA FORM

Student Information

Student's Legal Name:

Email Address:
 

Cell Phone Number:
 

Enrollment Information

In 2012-2013 will you be a:
Undergraduate Student
Graduate Student (Master's Degree)

When is your anticipated college graduation?
Summer 2012 Fall 2012 Spring 2013 Summer 2013 or Later

What is your anticipated enrollment for the 12-13 year?
Please list the number of credit hours you plan on taking each semester:
Summer 2012 
Fall 2012 
Spring 2013 
Summer 2013 

Other Information

Are you currently incarcerated or under house arrest?
No
Yes

Do you have family members who will be attending Southwestern in 2012-2013?
No
Yes

If Yes, please list

Name:

Relation to You:

Name:

Relation to You: