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Western Kentucky University

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Prospect Information Form

 

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Information Please enter the requested information. Please note that an asterisk denotes required information.

 
 
 
 

Student Name

 
 
 
 
 

Address (Mailing address or email address is required.)


 
 
 
 
 
 
 

(xxxxxx)-(xxxxxxxxxxxx)
-
 
 

(xxxxxx)-(xxxxxxxxxxxx)
-
 
 
Date of Birth: Required
Month
Day
Year
(YYYY)
 

Email Address (Mailing address or email address is required.)

 
 

Parent Email Address

 
 

High School Information

 
OR
 
 
 
 
 
 
 
 
 
 
Graduation Date:
If unsure of exact date, please estimate. If you have not yet graduated high school, list your anticipated graduation date.
Month
Day
Year
(YYYY)
 
 

Test Score and GPA

 
 

College Information

 
 
 
 
 
 
 
 
 
 
 
Graduation Date:
Month
Day
Year
(YYYY)
 

(example: 9.99)
 

Major of Interest

 

To select multiple items, use Ctrl+Click for PC or Command+Click for Mac.
 


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