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Contact Information

First Name

Last Name

Email Address

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Birth Date

Please enter using this format: MM/DD/YYYY. Be sure to enter the correct year and not the current year.

Mobile Phone

Home Phone

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Mailing Address

City

State/Province

ZIP/Postal Code

Country

High School Graduation Year

Enrollment Information

Entry Term:

Possible Major 1

Possible Major 2

Location Preference

Jackson - Academic/Technical Center

Utica Campus

Jackson - Nursing/Allied Health Center

Vicksburg Campus

Rankin Campus

Online Classes

Raymond Campus

Other Interests

Athletics

Honors

Band

Housing

Cheer

International Studies

Choir

Intramural Sports

Dance

STEM

Hinds Connection

Student Government

Hi-Steppers

Theater

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Contact Information

Enrollment Information

Location Preference

Other Interests

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