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Student Information Request Form

Please use the form below to request an informational packet from the colleges you are interested in attending. All collected information will be shared only with members of College Outreach USA (The Colleges). We never sell or trade information collected through this site.

All fields marked with an "*" are required.

*Name:

*Home Address:


*Home City:                                 *Home State:     * Home Zip:

*Home Phone:

*E-mail address:

*Date of Birth:
Month: Day: Year:
*Year of High School Graduation:

*Present School:

School Address:


*School City:                               *School State:      School Zip:

School Phone:

*School Counselor:

Rank in Class:           Out of?:                   *GPA:
     
Intended Major:

 Gender*
Male Female

Optional: Does the student wish to be identified as a member of the following groups?

African American   Asian/Pacific Islander  Caucasian  Hispanic
Native American/Native Alaskan     Other

Select Colleges: Please select up to 15 of the following colleges you are interested in attending and from which you would like to receive more information.

Albertus Magnus College Northwestern University
American University Quinnipiac University
Bentley University Princeton
Boston University Sewanee: The University of the South
Brown University Southern Methodist University
Clark University St. Lawrence University
Coe College Stanford University
Dartmouth Swarthmore College
Davidson College Texas Christian University
Denison University Tuskegee University
Duke United States Air Force Academy
Emerson College United States Naval Academy
Emory University University of Michigan
Fisk University University of North Carolina at Chapel Hill
Fordham University University of Oregon
George Washington University University of Pennsylvania
Harvard University of Southern California
Indiana University University of Virginia
Ithaca College Washington & Lee
Lawrence University West Point
Marquette University Yale
Northeastern University  

 

If you would like more information about a college that you don't see listed

above, please write the name of the college in the box below:


 

Additional comments or suggestions:

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