Please take a few minutes to fill out this form so we can learn more about you and provide the information that most interests you.

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*First Name:
*Last Name:
*Address:
*City:
*State:
*Zip:
*Country:
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*Email:
*Gender:	Make a selection: Male Female
*How did you hear about us?	Make a selection: TV Ad Radio Ad Web Ad LoHud.com Newspaper Ad College Search Website Facebook Twitter YouTube Email College Guide Postcard Friend Alumni Other
*High School/College last attended:
*High School Grad Year:
If college, number of credit hrs.:
*Planned Date Of Enrollment	Make a selection: Spring Fall
	Make a selection: 2011 2012 2013
SAT Score (Verbal):
SAT Score (Math):
SAT Score (Writing):
SAT Total:
ACT:
High School GPA:
TOEFL:
College GPA:
Program of Interest:
Please check activities/programs you would like to pursue in college:
Baseball	Community Service
Basketball	Student Government
Soccer	Ethnic/Cultural Clubs
Softball	Religious Activities
Tennis	Intramural Athletics
Volleyball	Study Abroad
Cross Country	Honors Program
Drama	Internships
Yearbook	Music Choral
Newspaper	Music Instrumental
Academic Clubs	Men's Golf
If others, please specify:
Do you have a special interest or talent that we should know about?
Have you visited the Concordia-New York campus	- Select One - Yes No
How would you describe your interest level in Concordia College-New York?	- Select One - Very Interested Somewhat Interested Uncertain

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