Prefix:       

First Name:

Last Name:

Nickname:  

Address Type

Address Line 1

Address Line 2

City

State

County (If Virginia resident)

Zip Code

E-mail Address

Phone Number

Term
Summer Session Full
Fall
Spring

Year

Academic Interests
Applied Science BSA: Management Science
Computer Info System PE: Sport Management
Sociology Sociology/Criminal Justice

High School and Previous College Information

*Enter High School Information First

Start Date    (MM/DD/YYYY)

End Date  (MM/DD/YYYY)

Name of High School

City

State

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Start Date    (MM/DD/YYYY)

End Date  (MM/DD/YYYY)

Name of 1st College

City

State

Degree

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Start Date    (MM/DD/YYYY)

End Date  (MM/DD/YYYY)

Name of 2nd College

City

State

Degree

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Type "AVERETT" in the Box