Privacy Policy

View our privacy policy for details on use and storage of the personal data you will enter on this form. Then, please select the checkbox to provide your consent to these terms and conditions.

Please provide your consent

Yes, I consent

Personal Information

Legal First Name

Legal Last Name

Full Middle Name

Have you ever had a different last name?

YesNo

Different Last Name

Personal Email

Date of Birth (MM/DD/YYYY)

Primary Phone

Mobile

Home

Secondary Phone

Mobile

Home

Permanent Address

Country

Street - Please include your unit or apt. number if applicable.

City

State

Zip/Postal Code

Is your permanent living address the same as your mailing address?

YesNo

Mailing Address

Country

Street - Please include your unit or apt. number if applicable

City

State

Zip/Postal Code

Social Security Number

Providing your Social Security Number allows UNH College of Professional Studies to identify and verify student records in order to comply with IRS reporting requirements related to federal education tax benefits.

Please enter your SSN with NO DASHES

Demographic Questions

The following information is used for statistical purposes only. Your responses are optional.

Gender

Are you Hispanic or Latino?

Please indicate how you identify yourself? You may check more than one

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Pacific IslanderWhite

High School Information

Name of High School

As you type, a list of schools will automatically appear; please select your school from the list.

If your school does not appear, type and select "Unknown", then provide it in the field below, including the school's name, city and state.

School or program name (if not listed above)

Grade Level

Expected Graduation Date

School Counselor

Course Information

Semester

Courses

Signature

I certify that the information on this form is true.

Yes

Electronic Signature (please type your name)

VLACS

True

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