TEXAS A&M UNIVERSITY-TEXARKANA

Enrollment Management Office
7101 University Ave.
Texarkana, TX 75505-5518
(903) 223-1353
www.tamut.edu/recruitment

Contact Information

	Last Name:
	First Name:
	Address:
	City:
	State:
	Zip Code:
	Home Phone Number:
	Cell Phone Number:
	Email Address:
	Date of Birth (ex. 3/8/2009):
	When do you plan to enroll (ex. Spring 2011):
	Gender:	-- Select --- Male Female
	High School or Coll. Last Attended:
	Major:
	Classification:	-- Select --- Freshman Sophomore Junior Senior
	Ethnicity:	-- Select --- American Indian Caucasian African-American Hispanic Asian-American Other
	Ethnicity (if other):
	Please send me:	Application   Catalog Financial Aid Information Viewbook   Schedule Scholarship Information

State law requires that you be informed of the following: (1) you are entitled to request to be informed about the information about yourself collected by use of this form (with a few exceptions as provided by law); (2) you are entitled to receive and review that information; and (3) you are entitled to have the information corrected at no charge to you. For more information see our Privacy Statement.