Student Registration Form
Student Name*
Email Address*
Home Address*
City/Sate/Zip*
Student Phone*
Name of Parent/Guardian*
Email address*
Parent Phone*
Name of High school*
School counselor*
GPA
ACT score*
SAT score*
PSAT*
Grade level
Expected High school graduation date
Current Interest (s) i.e. Major/Minor
Hobbies/Talents
Level of interest in attending Southern University
Tee-shirt size
