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Blinn College

 

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Blinn College Prospect Information Form

  

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Information Please enter the requested information.

* - indicates a required field.

Your prospect information will be processed by the Blinn College Recruiting Office. Correspondence from Blinn College will be sent to your email address. If you do not already have an email address, you can create a Yahoo email address now for free. For questions, please call (979) 830-4152.

We value your privacy. This information will not be shared or sold to any third party.

Required - indicates a required field.
Name
Prefix:
First Name: Required
Middle Name:
Last Name: Required
Suffix:
Nickname:

Information Please enter your current home address.

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

Information Please enter your email address. You will be contacted by email with information about Blinn College.

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

Information Please enter your birthdate.

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

Information Please tell us how you learned about Blinn College.

How Did You Learn About Us?
How I Learned About Blinn College:Blinn College

Information Which term do you plan to enroll at Blinn College?

Entry Term
Term of Entry:Required

Information Please select your high school from the drop down list.

High School
Home Schooled (check for yes):
OR
High School Code:
High School Name:Required
Address Line 1:
Address Line 2:
Address Line 3:
City:Required
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+)

Gender
Gender:Required Male Female Not Specified

Ethnicity/Race
Ethnicity:Required

Note What is your ethnicity?

Ethnic Category:Required
Hispanic or Latino
Not Hispanic or Latino

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

Race:Required
American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Unknown Race
American Indian, Alaska Native
Asian
Black, African American
Native Hawaiian, Other Pacific
White
Unknown Race

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Release: 8.7.2.12