STUDENT INFO

First Name

Middle Name

Last Name

Street Address

City

State or Province

Zip/Postal Code

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Home Phone

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Parent Email

Gender

Birthdate (mm/dd/yyyy)

ACADEMIC INTEREST

Anticipated Start Term

Anticipated Start Year

Desired Level

Student Type

Major of Interest

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What school do you currently attend or did you most recently attend?

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How did you first learn about Point Park University?

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