Student's Legal Name:
Email Address:
Cell Phone Number:
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
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:
