Fields marked with * are mandatory
General

Legal First Name *
*Please enter valid Legal First Name
Last Name *
*Please enter valid Last Name
Preferred Name
*Please enter valid Preferred Name
Middle Name
*Please enter valid Middle Name
Prefix
*Please enter valid Prefix
Email Address *
*Please enter valid Email Address
Home Address 1 *
*Please enter valid Home Address 1
Home Address 2
*Please enter valid Home Address 2
City *
*Please enter valid City
State *
*Please enter valid State
Zip *
*Please enter valid Zip
Country
*Please enter valid Country
Citizenship
*Please enter valid Citizenship
Sex *

*Please enter valid Sex
Contact Number
*Please enter valid Contact Number
Cell Phone Number
*Please enter valid Cell Phone Number
Graduation Year *
*Please enter valid Graduation Year
Student Type

*Please enter valid Student Type
Entry Term *
*Please enter valid Entry Term
Date of Birth *
*Please enter valid Date of Birth
Background

Parent/Guardian 1 Name
*Please enter valid Parent/Guardian 1 Name
Parent/Guardian 2 Name
*Please enter valid Parent/Guardian 2 Name
Sibling(s) / Name(s) and Age(s)
*Please enter valid Sibling(s) / Name(s) and Age(s)
Academic

High School *
School Name
Address1
Address2
Address3
City
State
Zip
Country
CEEB Code
the school is not listed above
*Please enter valid High School
Class Rank
*Please enter valid Class Rank
GPA
*Please enter valid GPA
SAT Total
*Please enter valid SAT Total
ACT
*Please enter valid ACT
Other College Choices
*Please enter valid Other College Choices
Academic Interest(s)
*Please enter valid Academic Interest(s)
Athletic

High School Coach Name
*Please enter valid High School Coach Name
High School Coach Email
*Please enter valid High School Coach Email
Cross Country Honors (Best Performances/Times)
*Please enter valid Cross Country Honors (Best Performances/Times)
Track Honors (Best Performances/Times)
*Please enter valid Track Honors (Best Performances/Times)
Do you know any current Luther Students or Alumni?

*Please enter valid Do you know any current Luther Students or Alumni?
If so, Who?
*Please enter valid If so, Who?