Name: *

Email Address: *

Phone Number: *

Address: *

City: *

State: *

Zip Code: *

Birthdate:

High School:

Have you attended any other Universities? Yes No If so, which one?

University Attending: University of Texas Austin Community College St. Edwards

Major:

Classification: Freshman Sophomore Junior

Summer Orientation Dates (if applicable):

Do you know any current members in Sammy? Yes No If so, who?

Are you a legacy? Yes No Who was it? Relation to you:

Any additional comments: