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Southern Oregon University Self Service

 

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Prospect Information Form

 

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Information Please enter the requested information. Please note that an asterisk denotes required information. COUNTY is only applicable for Oregon residents. In INTERESTS, to select multiple values use Ctrl+Click for PC and Command+Click for Mac.

Required - indicates a required field.
Name
Prefix:
First Name: Required
Middle Name:
Last Name: Required
Suffix:
Nickname:

Mailing 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:

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

Citizenship
Citizenship:Required

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

Term You Want to Start at SOU
Term of Entry:Required

Ethnicity/Race
Ethnicity:

Note What is your ethnicity?

Hispanic or Latino
Not Hispanic or Latino

Note Select one or more races to indicate what you consider yourself to be.

American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
Alaskan Native
American Indian
American Indian - Other
American Indian - Paiute (Burns OR)
American Indian - The Klamath Tribes
Cherokee
Coquille Indian Tribe
Cow Creek Band of Umpqua Indians
Grand Ronde
Navajo
Nez Perce
Piute
Siletz
Sioux
Tribes of Coos, Lower Umpqua and Siuslaw
Umatilla
Wasco/Warm Springs
Yakama
Asian
Asian - Other
Asian Indian
Cambodian (Kampuchean)
Chinese
Filipino
Hmong
Indonesian
Japanese
Korean
Laotian
Mienh
Pakistani
Thai
Vietnamese
Black or African American
Fijian
Guamanian
Hawaiian
Melanesian
Micronesian
Pacific Islander
Pacific Islander - Other
Polynesian
Samoan
Tongan
Algerian
Armenian
Azerbaijani
Baluchi
Bedouin
Berbers
Copts
Druze
Egyptian
Hazara
Iranian
Iraqi
Israeli
Jordanian
Kurd
Lebanese
Libyan
Maronite
Middle Eastern
Middle Eastern - Other
Moroccan
North African
North African - Other
Nubian
Palestinian
Pushtun
Qashqa'i
Saudi
Somalis
Sudanese
Syrian
Tunisia
Turks
White
Yazidis
Yemenis

Gender
Gender:Required Male Female Not Specified

Information To select multiple values use Ctrl+Click for PC and Command+Click for Mac.

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