Pre-College Program Interest

I'm Requesting Information as a: *

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Personal Information

Student First Name *

Preferred First Name (Nickname)*

Student Last Name *

Email Address *

Parent Email Address

Mobile Number

Mailing Address *

Country

Street

City

Region

Postal Code

Birthdate *

Gender

Ethnicity

Religious Preference

Academic Information

Student would be starting College in: *

Is student a Lipscomb legacy student? * (Lipscomb defines legacy students as students who have had a parent, grandparent, or sibling attend Lipscomb.)

Please indicate your legacy relationships:

High School *

Primary Academic Area of Interest *

Pre-College Program Interest

Interaction - Web Inquiry (Hidden)

Brother(s)
Father
Grandfather
Grandmother
Mother
Sister(s)