Search Purdue

About Us
Admissions
Academic Programs
Units
Outreach
News & Events
- Calendar
- HHS Publications

Your Name
Friend's Email Address
Comments

Student Information

Please complete and submit this form at your earliest convenience.
In order to better serve you, we will need this form no later than 5 days before your STAR date.

The information you provide on this form is confidential and will be sent directly to your Academic Advisor

General Information

First Name:	Middle Name:	Last Name:
Preferred First Name:
Hometown:	Cell Phone Number:	Purdue ID:
Purdue Email Address:	Second Email Address:
Where will you be living on campus?

Education (High School)

High School:

City of High School:

A/P Exams taken in high school:
Exam Name:	Score:

Dual Credit courses taken in high school:
Course:	Grade:

Have you established credit at another university? If so, please indicate all courses and the grades you expect from each.

List your school extracurricular activities:
Activity:	Office Held/Notes:

About You

Describe your work experience:

List your leisure time activities and hobbies:

Please indicate, in a few sentences, what your major interests are and why you selected your current major:

What do you consider your greatest strength?

What do you consider your greatest weakness?

What is the last good book you've read?

List your computer skills:

Purdue

Do you plan on taking any exams during STAR? (check all that apply):

Foreign Language
Math
Chemistry
COM 114

Which Purdue orientation programs have you attended? (check all that apply):

Introducing Purdue
Purdue's For Me
Fall Preview Days
Admission Campus Tour
Individual meeting with a Purdue Advisor in
Other:

Will you attend Boiler Gold Rush?

During my first semester/year at Purdue I plan on... (check all that apply):

working part time hours
participating in Intercollegiate Athletics
participating in Band
participating in clubs and organizations
rushing a fraternity or sorority
Other:

During my first semester/year at Purdue, I anticipate needing assistance in the following areas (check all that apply):

study skills
reading skills
writing skills
biology
chemistry
mathematics
physics
career counseling
personal counseling
interest or aptitude testing
test anxiety

Optional

Answering the following questions is OPTIONAL, but your responses would be helpful to us:

Father's Name:	Occupation:	Level of school completed:
Mother's Name:	Occupation:	Level of school completed:
Number of Siblings:
Do your siblings attend Purdue or Other universities?
Do you have any relatives who are Purdue Alumni?

Feedback | E-mail Webmaster
Maintained by: Purdue Marketing Communications

Purdue University, West Lafayette, IN 47907
(765) 494-4600, E-mail: marketing@purdue.edu
© 2010 Purdue University | An equal access/equal opportunity university | Copyright Complaints
If you have trouble accessing this page because of a disability, please contact Purdue Marketing and Media at marketing@purdue.edu.

Purdue University

College of Health and Human Sciences

Student Information