Galion and Mansfield Regional

Student Information

Student First Name

Student Last Name

Date of Birth

Gender

Student's Email Address

Student Address Information

Country

Street

City

Region

Postal Code

Student's Cell Phone

Home Phone

Student's Educational Information

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High School

CEEB Code

HS Cumulative GPA

HS Graduation

Student's Anticipated Enrollment Information

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Type Of Student:

First Year Student

Transfer Student

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Entry Year and Term

Expected Major

2nd Expected Major

Student's Collegiate Interests

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Campus Location