Information Request Form

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First Name*	Street Address*
Middle Name	City*
Last Name*	State*
Email Address	ZIP
Area Code and Telephone (###) ###-####	Country

Gender	High School Graduation Year (if enrolling as a Freshman)
I will enroll as a *	I am applying for the term beginning*

High School CEEB Code	SAT Verbal score
High School GPA	SAT Math score
ACT Composite score	TOEFL total score
College GPA (if applicable)

First academic program of interest	Second academic program of interest


Jacksonville University · 2800 University Boulevard North · Jacksonville, Florida 32211 · 904-256-8000