Prospect Inquiry

Contact Information

Legal First Name

Legal Last Name

Email Address

Please use a personal email account to create your application. DO NOT use a college, university, or high school assigned email account.

Confirm Email Address

Please use a personal email account to create your application. DO NOT use a college, university, or high school assigned email account.

Preferred Phone

Mobile Phone

Home Phone

This number is used to contact enrolled students if the college should need to communicate by phone with students. It can be a mobile phone from the previous field or a landline.

Text Messaging

If you wish to receive important text messages regarding your application and enrollment information, choose Allow to opt in below. Cancel at any time by texting "STOP" and to resubscribe, reply "START". For help, reply "HELP" or email SO-CRMRecruitSupport@ct.edu or call 866-523-6008. Message and data rates may apply. Frequency of messaging is 4 per month per application. For more information, please view our terms of service and privacy notice.

Do Not AllowAllow

Birth Date

(mm/dd/yyyy)

Permanent Address

Country

Address

Address (cont)

City

ZIP/Postal Code

Entry Term

Academic Level

Academic Program