Inquiry Form

YOUR JOURNEY BEGINS HERE!!
Complete this form to be added to our exclusive contact list.

Personal Details

First Name*

Preferred Name

Middle Name

Last Name*

Birthdate*

Contact Information

Email Address*

Mobile Phone Number

Would you like to receive text messages from Southern University?*

Yes

No

Country

Street

City

Region

Postal Code

Inquiry Details

Student Type*

Intended Major*

Intended Semester*

Intended Year*

Academic Information

High School Name

College Name

Additional Information

Select any additional information you'd like to provide:

Athletic Interests

Select a sport that you would be interested in playing at SUBR:

Sport Name

Add Another

Yes

Sport Name

Add Another

Yes

Sport Name

ACT Scores

ACT Composite Score

Test Date

Add Another

Yes

ACT Composite Score

Test Date

Add Another

Yes

ACT Composite Score

Test Date

SAT Scores

SAT Total Score

Test Date

Add Another

Yes

SAT Total Score

Test Date

Add Another

Yes

SAT Total Score

Test Date

Parent/Guardian Information

Type

First Name

Last Name

Email Address

SUBR Graduate?

Yes

No

Add Another

Yes

Type

First Name

Last Name

Email Address

SUBR Graduate?

Yes

No

Add Another

Yes

Type

First Name

Last Name

Email Address

SUBR Graduate?

Yes

No