First Name *
Last Name *
Student's Email (must be unique) *
Preferred Phone
Mobile Phone *
Home Phone *
Gender *
Birthdate *
Street *
City, State/Province, and Postal Code *
Country *
Mother's Email
Father's Email
High School Name
Emergency Contact from Sending School - Name and Phone *
High School Graduation Year *
High School GPA *
College Entry Term *
When I go to college I am interested in studying *
Race (select all that apply) *
Hispanic or Latino: *
Have you personally accepted Jesus Christ as your Savior? *
Tell us about yourself. Please provide a one paragraph self-introduction. *
T-Shirt Size *
Please list any dietary restrictions, special housing needs, or roommate requests.
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