New Student Verification Form

Student Information

First Name

Preferred First Name

Middle Name

Last Name

Birthdate:

Student Cell Phone Number

By giving us your number you agree to receive messages about admission events and application updates. You may opt out of these messages at any time.

Student Email Address

In accordance with Federal Law, please confirm your race/ethnicity:

Are you Hispanic?

Please check one or more of the following groups in which you consider yourself to be a member:

Are you a first generation college student (no parent or guardian has earned a four year college degree)?

Yes

Gender

Religious Preference

If other, please list religious preference:

Martial Status

T-Shirt Size

By checking this box I am verifying the above information is correct.

Yes

I understand that my withdrawal from Centenary, change of class schedule, and financial obligations are subject to the regulations in the current catalog as stated or amended. By checking this box I attest to this understanding, to the accuracy of the information above, and to my intentions to abide by the Centenary Honor Code.

I understand