Office of Admissions Information Request Form - Higher Education Center McAllen

HIDDEN: HECM Interest

Student Information

Please complete using your full legal name as it appears on your birth certificate or passport.

* Indicates a required field or an issue in the form.

Student First Name/Given Name*

Student Middle Name

Student Last Name/Family Name*

Student Birthdate*

I am a prospective...*

Term of Entry*

1st Choice Major

2nd Choice Major

High School*

Term of Entry*

1st Choice Major

2nd Choice Major

Most Recent College Attended*

Student Street Address*

Country

Street

City

Region

Postal Code

Student Phone Number

Student Personal E-mail*

Student Gender

Female

Male

Student Ethnicity

Hispanic or Latino

Not Hispanic or Latino

Please select the racial category or categories with which you most closely identify. Check as many as apply.

Student Race

Parent Information

Would you like provide Parent/Guardian information?

Yes

No

Parent/Guardian Relationship Type

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address

Military Affiliation

Are you military affiliated?

Yes

No

If so, what is your affiliation?