Recruitment Contact Information Form

Contact Information

*First Name	*Last Name
Gender: Male Female	Date of Birth:
*Address:	*City:
*State:	*Zip:
*Phone: - -	High School or College:
Ethnicity	*Email Address:
If Ethnicity is Other:
Classification:	Major:
Please Send Me: Application Catalog Viewbook Financial Aid Info Scholarship Info Schedule and THEA Info
* This is a required field

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.