Prospect Data Entry Form

Please enter your information in the following forms.

- indicates a required field.

Type your name using mixed case. (Correct: John Doe Incorrect: JOHN DOE)

Prospect Name
Prefix:
First Name:
Middle Name:
Last Name:
Suffix:
Nickname:

Prospect Gender
Gender:	Male	Female	Not Specified

Prospect Birthdate
Date of Birth:	Month Day Year (YYYY)

Primary Address
Valid From:	Month Day Year (YYYY)
Until:	Month Day Year (YYYY)
Address Line 1:
Address Line 2:
Address Line 3:
City:
State or Province:
ZIP or Postal Code:
County:
Nation:
Phone Number:	- (xxxxxx)-(xxxxxxxxxxxx) (xxxxxxxxxx extension)
International Access Code:

Prospect Ethnicity/Race
Ethnicity:

What is your ethnicity?

HispanicNot Hispanic

Hispanic or Latino
Not Hispanic or Latino

Hispanic or Latino

Not Hispanic or Latino

Select one or more races to indicate what you consider yourself to be.

American Indian or Alaska Native	Asian	Black or African American	Native Hawaiian or Other Pacific Islander	White	Hispanic	No response	Other
American Indian, Alaskan Native	Asian Asian Pacific Islander	Black or African American	Native Hawaiian/Pacific Island Puerto Rican - Commonwealth Puerto Rican - Mainland	White	Cuban American Hispanic Mexican American	Individual declined	Other

Prospect Citizenship
Citizenship:

Type your complete e-mail address. If you do not have one, you can create your own personal e-mail address at www.hotmail.com or www. yahoo.com

E-Mail Address
E-mail Address:
Verify E-mail Address:

Prospect Entry Term
Term of Entry:

This is sample information text for the STUDENTTYP section. Modify or delete this text by choosing the Customize a Set of Information Text option on the Web Tailor Administration menu and selecting the hwskwpro.P_WebProspectMain procedure.

Prospect Student Type
Student Type:

Prospect Major
Major:

Prospect High School
Home Schooled (check for yes):
OR
High School Code:
High School Name:
Address Line 1:
Address Line 2:
Address Line 3:
City:
State or Province:
ZIP or Postal Code:
Nation:
Graduation Date:	Month Day Year (YYYY)
Class Rank and Size:	/ (must be numeric)
GPA:	(example: 9.99, or A+)

Please select the how you learned about WSSU.

How Prospect Learned About Us
How I Learned About :

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Release: 8.7.2.12

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