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CONTACT & personal INFORMATION

Program Delivery

First Name Last Name

Mailing Address Date of Birth

City State

Zip Home Phone

E-Mail Address Cell Phone

Gender I will enroll as a

In what varsity sport are you interested?

What musical instrument(s) do you play?

How did you first hear about Southeastern?

If Other >>

What interests you most about Southeastern University?

ACADEMIC INFORMATION

Planned Enrollment Date

Have you submitted an application?

If yes, when?

What high school did you attend?

What city was your high school located?

What college or university have you attended?

How many semester of credit hours have you earned?

Did (will) you receive a HS diploma or a GED?

CHURCH INFORMATION

What church do you attend? Where is your church located?

What denomination is your church?

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