USM Lewiston-Auburn College Information Request Form

Still have more questions? We would love to talk to you about your academic or career goals. Our Academic Advisors help prospective students navigate through all the requirements necessary to get started. Request an appointment by completing and submitting the form below. A representative will get back to you soon.

(Required fields are indictaed with *)

Last Name*
First Name*
Street / PO Box*
City / Town*
State / Province*
Country
Zip / Postal Code*
Phone Number*
E-mail Address:
Date of Birth (mm/yy/yyyy) *
Gender:	Male Female

If you have not completed high school yet or have graduated from high school within the past three (3) years, please indicate the high school attended:

Graduation date:

Would you like a tour of USM LAC? Yes No

I am interested in the following program:

I am interested in the following minor:

How did you hear about USM's Lewiston-Auburn College?

Newspaper Ad	Radio Ad
Web Search	Guidance Counselor
Mail	Co-Worker/Employer
College Fair	Friend
Other

If Other:

Other Comments:

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