Viterbo University

First Name

Last Name

Chosen First Name

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Pronouns

Email Address

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Cell Phone:

Home Phone

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Birth Date (mm/dd/yyyy):

Legal Sex

Gender Identity

Extracurricular Interest

Have you, your spouse, or your parent(s) served in the U.S. Military?

Are you an international student?

Please select NO to this question if you are a U.S. Citizen and/or hold a U.S. greencard.

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Address

City

State

ZIP/Postal Code

Academic Area

Undergraduate – high schools students, transfer students, and traditional-aged prospective college students
Bachelor Completion – adult students interested in online/evening courses, including RN to BSN completion
Graduate – prospective students with undergraduate degrees interested in a master’s degree, doctoral degree, or a graduate certificate/license, including the post-baccalaureate teacher licensure

Academic Program

Entry Term

Admit Type

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Prospect Inquiry