UG-CPN- Pleasantville Senior Panel

Personal Information

First Name

Last Name

Birthdate

Gender

Contact Information

Email Address

Mobile Phone

Current Address

Country

Street

City

Region

Postal Code

Parent or Guardian Information

Type

Parent or Guardian Email Address

Parent or Guardian First Name

Parent or Guardian Last Name

Academic Information

Admit Type

Entry Term

High School Name

High School CEEB Code

Most Recent College or University

College or University CEEB Code

Plan of Study:

Special Programs:

(Use the ctrl key to select more than one option)

*Five-year dual degree programs offered in Chemistry, Computer Science, Criminal Justice, Economics, Mathematics, MBA, and Psychology

Pre-Professional Programs:

(Use the ctrl key to select more than one option)

Major of Interest