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Student Information Request Form

Please use the form below to request an informational packet from the colleges you are interested in attending. All collected information will be shared only with members of the Outreach Consortium (The Colleges). We never sell or trade information collected through this site.

All fields marked with an "*" are required.

*Name:

*Home Address:


*Home City:                                 *Home State:     * Home Zip:

*Home Phone:

*E-mail address:

*Date of Birth:
Month: Day: Year:
*Year of High School Graduation:

*Present School:

School Address:


*School City:                               *School State:      School Zip:

School Phone:

*School Counselor:

Rank in Class:           Out of?:                   *GPA:
     
Intended Major:

 Gender*
Male Female

Optional: Does the student wish to be identified as a member of the following groups?

African American   Asian/Pacific Islander  Caucasian  Hispanic
Native American/Native Alaskan     Other

Select Colleges: Please select up to 15 of the following colleges you are interested in attending and from which you would like to receive more information.

Albertus Magnus College Northeastern University
American University Northwestern University
Bentley University Quinnipiac University
Boston University Princeton
Brown University Sewanee: The University of the South
Clark University Southern Methodist University
Coe College St. Lawrence University
Dartmouth Stanford University
Davidson College Texas Christian University
Denison University Tuskegee University
Duke United States Naval Academy
Emerson College University of Michigan
Emory University University of North Carolina at Chapel Hill
Fisk University University of Oregon
Fordham University University of Pennsylvania
George Washington University University of Southern California
Harvard University of Virginia
Indiana University Washington & Lee
Ithaca College West Point
Lawrence University Yale
Marquette University  

 

If you would like more information about a college that you don't see listed

above, please write the name of the college in the box below:


 

Additional comments or suggestions:

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