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Contact Information

Legal First Name

Legal Last Name

Email Address

Confirm Email Address

Preferred Phone

Please only provide a phone number in the Mobile or Home text box. If there is none available in your non-preferred number, leave blank.

Mobile Phone

Home Phone

Text Messaging

If you wish to receive important text messages regarding your application and enrollment information, choose Allow to opt in below. Cancel at any time by texting "STOP" and to resubscribe, reply "START". For help, reply "HELP" or email SO-CRMRecruitSupport@ct.edu or call 866-523-6008. Message and data rates may apply. Frequency of messaging is 4 per month per application. For more information, please view our terms of service and privacy notice.

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Birth Date

Country

Address

Address (cont)

City

State/Province

ZIP/Postal Code

High School 1

School Name or City (full or partial) In order to search by name, enter at least 3 characters of the name. Country

Unlisted High School Name and Address

Home Schooled

Do you anticipate graduating?

Month started Attending

Year started Attending

Month Anticipate Graduation

Year Anticipate Graduation

Counselor's First Name

Counselor's Last Name

Counselor's Email

Counselor's Phone

GPA

GPA Conversion Scale

Select the grading scale from your high school.

College

Entry Term

Student Type

Your college contact should have indicated which type to choose below

Account Information

Password

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Contact Information

High School 1

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