Student_Register

Saturday, July 31, 2010

New Student Registration

Welcome to College Bound eProfiles!
Below you are going to enter basic information about yourself. This information will be used as you build your personal ePAQs. It is important that the information that you enter below is accurate and up-to-date.

Registration Info

eProfiles License Number:	License is expired License is expired
First Name:
Last Name:
User Name:
Password:
Confirm Password:
Email Address:	Don't have email? Try Free Yahoo email
Confirm Your Email:
Demo User (Program Directors only)

Contact Information
Street:
Street 2:
City:
State / Region:
Are you a U.S. Citizen / Permanent Resident?
Zip Code:
Home Phone:
Cell Phone:
Fax Number:
Website Address:	http://

Personal Information

Date of Birth:

(MM/DD/YYYY)

Gender:

FemaleMale

Ethnicity:

Alaskan NativeAmerican Indian
Asian/Pacific IslanderBlack (Non-Hispanic)
HispanicWhite (Non-Hispanic)
Bi-racial / Multi-racialOther
I prefer not to respond

(ethnicity description if needed)

Pre-College Program:

First Generation:

Languages Spoken Fluently:

EnglishSpanishChineseJapanese
FrenchGermanRussianOther

Family Information
	First Name	Last Name
Guardian (Mother):
Guardian (Father):
Guardian (Other):
Children in your family:

Current High School Information
High School Graduation Year:
High School State:
High School City:
High School:

Grades and Class Rank
By entering your cumulative GPA (Grade Point Average), you are verifying this information is accurate. If you are not sure what your current cumulative GPA is, contact your program director for assistance.
Cumulative GPA:		GPA Scale:
Class Rank:		Class Size:

Test Scores
Only enter scores for tests you have taken. By entering test scores below, you are verifying this information is accurate. If you are not sure what your test scores are, contact your program director for assistance.
ACT:		Best Overall SAT:
TOEFL:		SAT - Writing:
CLEP:		SAT - Critical Reading:
		SAT - Math:

This website is intended only for users over the age of 14; therefore, you must be at least 14 years of age to access or use this website. If you are between 14 and 18 years of age, you may access and use this website ONLY under the supervision of a parent or legal guardian.

All users of eProfiles must be at least 14 years old.

I am at least 14 years old:

Please check the box below with respect to the terms and conditions. By checking, you affirmatively agree to be bound to the terms and condtions, including without limitation of the Terms and Conditions and the Privacy Policy.

I have read and agree to the terms and conditions listed above.

7/31/2010 7:20:26 AM

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