Request for Information

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Student

Parent/ Guardian/ Family Member

Student Type

Your Information

First Name

Last Name

Email Address

Phone Number

Relationship to Student

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Your Information

Your Student's Information

First Name

Preferred Student Name

Preferred First Name

Last Name

Birthdate

Citizenship

Email Address

Mailing Address

Country

Street

City

Region

Postal Code

Cell Phone Number

Can we text you?

Yes

No

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Academic Information

Intended enrollment term

Current/most recent high school

Current/most recent post-secondary institution

Please indicate your programs of interest below. To select multiple options, please use the Ctrl key on windows and the command key on a mac.

Programs of Interest

Pre-Professional Programs (optional, in addition to program of interest)