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Request Information about Lake Superior College

First Name:*	First Name:*
Last Name:*	Last Name:*
Email Address:*	Email Address:*
What term do you intend on attending?:	What term do you intend on attending?:
What type of student are you?:	What type of student are you?:
Are you currently enrolled in High School?:	Are you currently enrolled in High School?:
High School Graduation Year:	High School Graduation Year:
High School State:	High School State:
High School Name:	High School Name:
High School Name (Other):	High School Name (Other):

Program of Interest 1:	Program of Interest 1:
Program of Interest 2:	Program of Interest 2:
Would you like to request information on additional programs?:	Would you like to request information on additional programs?:
Program of Interest 3:	Program of Interest 3:
Program of Interest 4:	Program of Interest 4:
Program of Interest 5:	Program of Interest 5:

I want LSC material mailed to me:	I want LSC material mailed to me:
Address:	Address:
City:	City:
State:	State:
Zip Code:	Zip Code:
Country:	Country:

Athletic Interest:	Athletic Interest:
How did you hear about us?:	How did you hear about us?:
I opt in to receive text messages from LSC:	I opt in to receive text messages from LSC:
Mobile Phone Number*:	Mobile Phone Number*:

By submitting this form, my data is available to this institution*:	By submitting this form, my data is available to this institution*: