Information Request Form

Please provide the following information:    * = required

First Name*

:::

 Middle Initial

Last Name*
Street Address*
(Please do not include punctuation.
If your address is P.O. Box, enter PO Box)
City*
If you are an international student please enter 00000 in the zip code box.
State *

Zip *  
Home Phone

Email Address*
Birth Date (MM/DD/YYYY) *

Ethnicity (optional)

Gender
High School Name or GED

High School Graduation Year*

High School GPA (GPA must be numeric) .
Probable Enrollment*
Enrollment Status

Name of Prior College (if applicable)
Academic Interest (Major)*
Only one choice can be made between Athletic and Club Interest
Athletic Programs
Clubs Interests
How did you First learn about Guilford?
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