Miniaci Lead Now Program Application

PERSONAL INFORMATION

Email

First Name

Middle Name

Last Name

Maiden Name

Address

City

State

Zip Code

Country

Evening Telephone Number

Day Telephone Number

Gender

MaleFemale

Social Security No.

Citizenship

Permanent U.S. Resident Alien

YesNo

Date of Birth

Select Date

Ethnicity

Current High School

Do you anticipate enrolling at St. Thomas University as a degree seeking student in the future?

YesNo

PARENT OR LEGAL GUARDIAN INFORMATION

Name

Relationship

Address

City

State

Zip Code

Evening Telephone Number

Day Telephone Number

Do you have any special needs (physical or dietary)?

How did you learn about this program?


Statement of Applicant:
I confirm that the statements contained in this application are true and accurate to the best of my knowledge. If admitted, I agree to comply with all laws and regulations of St. Thomas University. Credentials filed in support of this applicant become the property of St. Thomas University and will not be returned to the applicant.

Type Your Name

Date

Select Date

Statement of Parent or Guardian (if student is under 18):
I approve the above application and verify its accuracy. I understand and accept the regulations governing the acceptance of this application.

Type Your Name

Date

Select Date

St. Thomas University admits students of any sex, race, color, national and ethnic origin to all rights, privileges, and activities generally accorded or made available to students at the university. It does not discriminate on the basis of race, color, national or ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs.

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APPLICATION FOR THE MINIACI FAMILY LEAD NOW PROGRAM