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Arkansas Tech HELP | EXIT

Prospect Information Form

 

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Required - indicates a required field.
Information Please enter the requested information. Please note that an asterisk denotes required information.

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

Permanent 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:
County:
Nation:
Phone Number: - (xxxxxx)-(xxxxxxxxxxxx) (xxxxxxxxxx extension)
International Access Code:

Information Your entry term should reflect the year you are graduating from high school or finishing your home school program, or the term you expect to transfer.

Prospect Entry Term
Term of Entry:Required

Identify Your Student Level
Student Type:Required

Your Planned Major
Major:Required

Information When entering your e-mail address you will need to verify the address by entering it again. If you do not have an email address, you may enter no.email@noemail.com.

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

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

Prospect Gender
Gender:Required Male Female Not Specified

Information Ethnicity is a required field on our application due to federal and state reporting requirements which mandate the data collection.

Prospect Ethnicity/Race
Ethnicity:

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-Alaskan Native
Asian
Black or African American
Native Hawaiian-Pacific Island
White

Information If you were home schooled, enter HOME for the high school code. If you have a GED, enter GED.

Secondary School Information
Home Schooled (check for yes):
OR
High School Code:
High School Name:Required
Address Line 1:
Address Line 2:
Address Line 3:
City:Required
State or Province:
ZIP or Postal Code:
Nation:
Graduation Date: Month Day Year (YYYY)
Class Rank and Size: / (must be numeric)
GPA: (example: 9.99, or A+)

Prior College Information
College Code:
Prior College Name:
Address Line 1:
Address Line 2:
Address Line 3:
City:
State or Province:
ZIP or Postal Code:
Nation:
Attended From:
Attended To:
Graduation Date: Month Day Year (YYYY)
GPA: (example: 9.99)
Degree:

How did you learn about ATU?
How I Learned About ATU:ATU

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Release: 8.7.2.12