HU Application - Concurrent

Personal Information

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SEM_Import_Type

First Name *

Name Types

Middle Name

Name Types

Last Name *

Name Types

Citizenship

Please select: *

US Citizen Permanent Resident (for non US Citizens) Non US Citizen

Social Security Number (xxx-xx-xxxx)

(use dashes xxx-xx-xxxx)

Permanent Address and Contact Information

Address Line 1 *

Address Line 2

City *

State *

Zip Code/Postal Code

Country *

Cell Phone

+## (###) ###-####

Cell Phone *

By completing this application you are opting in to text communication. Click here if you'd like to opt-out of text messages.

Yes

Other Phone

+## (###) ###-####

Other Phone

Email *

High School Information

Name of High School

School CEEB

Graduation Date *

Parent/Guardian Information

Father/Step-Father/Legal Guardian First Name

Middle Name

Last Name

Father/Step-Father/Legal Guardian - Phone Number

Format: (260) 356-6000

Father/Step-Father/Legal Guardian - Email Address

Mother/Step-Mother/Legal Guardian First Name

Middle Name

Last Name

Mother/Step-Mother/Legal Guardian - Phone Number

Format: (989) 356-6000

Mother/Step-Mother/Legal Guardian - Email Address

server

Admissions Type

Site

Referral Source Date

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Personal Information

Citizenship

Permanent Address and Contact Information

Profile Information

Concurrent Student Course Selection

High School Information

Parent/Guardian Information