2014-2015 STUDENT DATA FORM

Student Information

Student's Legal Name:

Email Address:
 

Cell Phone Number:
 

Enrollment Information

In 2014-2015 will you be a:
Undergraduate Student
Graduate Student (Master's/EdD Degree)

When is your anticipated college graduation?
Summer 2014 Fall 2014 Spring 2015 Summer 2015 or Later

What is your anticipated enrollment for the 2014-2015 year?
Please list the number of credit hours you plan on taking each semester:
Summer 2014 
Fall 2014 
Spring 2015 
Summer 2015 

Other Information

Are you active military personnel, a veteran of the armed forces, a military spouse or a dependent of a military person?
No
Yes

Are you currently incarcerated or under house arrest?
No
Yes

Do you have family members who will be attending Southwestern in 2014-2015?
No
Yes

If Yes, please list

Name:

Relation to You:

Name:

Relation to You: