| First Name: |
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| Last Name: |
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| Birth Date: |
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| Mailing Address: |
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| City: |
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| State: |
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| Zip: |
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| Phone: |
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| E-mail: |
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If the email address provided above is not for the prospective student,
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| Name of e-mail recipient (if not the student) |
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| Relationship to the prospective student: |
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| Intended Major: |
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| Please select your student status: |
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| Winthrop Admission Status: |
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| Term and year for which you are applying: |
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| If you are a prospective freshman, please provide your high school information below: |
| High School: |
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| High School City: |
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| State: |
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| If you are a prospective transfer student, please provide information below on the last college: |
| College Name: |
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| College City: |
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| College State: |
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| Comments: |
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