Undergraduate Students | Request for More Information

PERSONAL INFORMATION

First Name*

A chosen name is the name that a person uses in their daily life that is different from their legal name. Please note that your chosen name will be used in all communication from Queens University of Charlotte.

Chosen Name*

Last Name*

Birthdate*

CONTACT INFORMATION

Mailing Address*

Country

Street

City

Region

Postal Code

Mobile Phone Number

May Queens send you text message(s) regarding your college search?

Yes

No

By checking this box, I consent to receive text messages from Queens University of Charlotte. Message and data rates may apply. Messaging frequency may vary. For help, text HELP. You may opt-out at any time by texting STOP.

Email Address*

ACADEMIC INFORMATION

I will be attending as a*

I am interested in the following academic area:*

Do you already have a bachelor's degree?

Yes

No

Do you currently have a valid nursing license?

Yes

No

I plan to start at Queens in:*

Will you be attending school on a visa?

Yes

No

The most recent school or institution I attended was:

*denotes a required field

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