Regional Interview: Mystic, Connecticut

Student Type*

Anticipated Entry Term*

Student First Name*

Student Middle Name

Student Last/Family Name*

Student Preferred Name/Nickname

Birthdate

Pronouns

Cell Phone Number

Student Email Address*

Confirm Email Address*

Parent/Legal Guardian Email Address (for additional communications)

Mailing Address*

Country

Street

City

Region

Postal Code

Please begin typing the name of your current school below and, when possible, select your school from the list. If your school is not found, please type the full name of your school.

High School/College*

CEEB - HIDDEN FIELD

HS level of study - default & hidden

Graduate

High School

Undergraduate

Academic Interest 1*

Academic Interest 2

Additional (Optional) Information requested for your Interview:

Activity 1

Activity 2

Activity 3

Self Reported SAT Critical Reading

Self Reported SAT Math

Self Reported ACT Composite

Self Reported GPA

Self Reported Class Rank

Lafayette Relative(s)