Student Life Information Form

First Name*

MI*

Last Name*

Email*

Cell Phone*

This number will only be shared with faculty and staff.

Vehicle Registration

If you plan to bring a vehicle to campus, please fill in the following information.

Make/Model of Vehicle

Year

State

Color

License Tag Number

Driver's License Number

Birthdate

State of License

Off Campus Students

Please give us your local address

Street Address Address Line 2 City