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Lehigh University Admissions Request for Information



Please enter your information in the following forms.

Please use the appropriate upper and lower case letters when completing the sections. DO NOT use all upper or lower case letters.

Required - indicates a required field.
Information Please enter your full legal name.

Last name = Family or Surname
First name = Given Name (NOT Nickname)
Suffix = e.g. II, III, IV

Name
Prefix:
First Name: Required
Middle Name:
Last Name: Required
Suffix:
Nickname:

Information Please enter your permanent address.

Please note: The last field in phone number is for extension only. e.g. 555 - 5553333 - ex. 12

International Students: Please enter country code in "Int'l Access Code" field and enter the remainder of your phone number in "Phone Number" field.

Primary Address
Valid From: Month Day Year (YYYY)
Until: Month Day Year (YYYY)
Address Line 1:Required
Address Line 2:
Address Line 3:
City:Required
State or Province:
ZIP or Postal Code:
County:
Nation:
Phone Number: - (xxxxxx)-(xxxxxxxxxxxx) (xxxxxxxxxx extension)
International Access Code:

E-Mail Address
E-mail Address:Required
Verify E-mail Address:Required

Prospect Birthdate
Date of Birth:Required Month Day Year (YYYY)

Gender
Gender:Required Male Female Not Specified

Information Please select the term you are interested in attending Lehigh.

Entry Term
Term of Entry:Required

Information You may select up to five interests. To select multiple interests use Ctrl+Click for PC and Command+Click for Mac.

Prospect Interests
Interests:Required

Information Please let us know how you found out about Lehigh.
To select multiple materials use Ctrl+Click for PC and Command+Click for Mac.

How Prospect Learned About Us
How I Learned About .: .

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