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The University of Wyoming

 

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Prospect Information Form

  

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Information Please enter the requested information. Please note that an asterisk denotes required information.

Required - indicates a required field.

Name
First Name: Required
Middle Name:
Last Name: Required
Suffix:
Nickname:

Primary Address
Valid From: Month Day Year (YYYY)
Until: Month Day Year (YYYY)
Address Line 1:Required
Address Line 2:
Address Line 3:
City:Required
State or Province:
ZIP or Postal Code:
Country:
Phone Number: - (Area Code) - (Number)

E-Mail Address
E-mail Address:
Verify E-mail Address:

SSN/TIN/TFN
U.S. Social Security Number: (999999999 or 999-99-9999; International students only need to fill this in if a SSN has been assigned to them.)

Birthdate
Date of Birth:Required Month Day Year (YYYY)

Gender
Gender: Male Female Not Specified

Ethnicity/Race

Note What is your ethnicity?

Hispanic or Latino
Not Hispanic or Latino

Note Select one or more races to indicate what you consider yourself to be.

American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
American Indian/Alaska Native
Asian - Far East Origin
Black/African American
Native Hawaiian/Pacific Island
White

Citizenship
Citizenship:Required

Student Type
Student Type:Required

Entry Term
Term of Entry:Required

Major
Major:Required

Secondary School/High School
Home Schooled (check for yes):
OR
High School Code:
High School Name:
City:
State or Province:
Country:
Graduation Date: Month Day Year (YYYY)

Prior College
College Code:
Prior College Name:
City:
State or Province:
ZIP or Postal Code:
Country:
Attended From:
Attended To:
Graduation Date: Month Day Year (YYYY)
Degree:

How Did You Learn About Us
How I Learned About The University of Wyoming: You may make multiple selections by holding down the Ctrl key when you click on an entry.

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