All fields marked with an asterisk (*) are required.
* First Name:
Preferred Name:
Middle Name:
* Last/Family Name:
Previous Last Name:
* Address Line 1:
Address Line 2:
Address Line 3:
* City:
* State:
* Zip/Postal Code:
* Country:
* Email Address:
Home Phone Number:
Cell Phone Number:
* Date of Birth:
High school graduation year:
* I want to enter Valpo as a:
* I want to start in:
Intended major:
Did either of your parents attend Valparaiso University?
Yes No