Request Information Form

Personal Information

E-mail Address: *

E-mail Address (Enter E-mail Address Again): *

First Name: *

Middle Name:

Last Name: *

Date of Birth: *

Phone Number: *

numbers only

Gender: *

Male

Female

Demographic Information

Citizenship:

Please enter your country of citizenship

Ethnicity (Optional)

Are you Hispanic/Latino? :

Yes

(select yes or no)

Regardless of your answer to the prior question, please indicate how you identify yourself:

American Indian or Alaska Native (including all Original Peoples of the Americas)

Asian (including Indian subcontinent and Philippines)

Black or African American (including Africa and Caribbean)

Native Hawaiian or Other Pacific Islander (Original Peoples)

White (including Middle Eastern)

(select one or more)

Mailing Address

Street Address: *

Street Address Line 2:

City: *

State (US Only):

Zip/Postcal Code: *

Country (if not United States):

Province (if not United States):

Enrollment Information

Desired Admission Type: *

Enrollment Term: *

Current School Information

High School Name: *

High School City, State: *

High School CEEB Code: *

Please enter your high school's six digit CEEB code. You may look-up the code by visiting http://sat.collegeboard.org/register/sat-code-search.

High School Graduation Date: *

College Name (Transfer, Combined Plan and Visiting Students Only):

College Class Standing:

Academic Interests

Possible Area of Study:

Possible Area of Study Two:

Possible Area of Study Three:

Other Information

Please share the information of your parents or guardians if you would like them to be contacted by Columbia.

Parent/Guardian 1 E-mail:

Parent/Guardian 1 E-mail 2:

Would you like to receive materials in the mail:

Yes

If No, we will only send information by e-mail.

How did you first hear about Columbia?:

Columbia University Office of Undergraduate Admissions

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