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University Of Michigan - Dearborn



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Information Please complete the following form to receive information about the University of Michigan-Dearborn.

For information on each item, see Help screen.

Important: Please use proper capitalization when completing this form (for example, use Joe Smith).

Required - indicates a required field.
Full Legal Name
First Name: Required
Middle Name:
Last Name: Required

Primary Address
Valid From: Month Day Year (YYYY)
Until: Month Day Year (YYYY)
Address Line 1:Required
Address Line 2:
Address Line 3:
State or Province:
ZIP or Postal Code:
Phone Number: - (xxxxxx)-(xxxxxxxxxxxx) (xxxxxxxxxx extension)
International Access Code:

E-Mail Address
E-mail Address:
Verify E-mail Address:

Date of Birth:Required Month Day Year (YYYY)

Gender:Required Male Female Not Specified

Information Although optional, providing your Social Security Number is important to ensure an accurate match between this inquiry and any financial aid, test score, or academic information we may receive.

U. S. Social Security Number
U.S. Social Security Number: (999999999 or 999-99-9999)

Anticipated Term of Entry
Term of Entry:Required

Program of Study

Information Please use the "Look Up High School Code" button below to get the information for your institution. If your institution is not available in our database, please enter your high school name, address, city, state, and zip.

High School Attended/Attending
Home Schooled (check for yes):
High School Code:
High School Name:Required
Address Line 1:
Address Line 2:
Address Line 3:
State or Province:
ZIP or Postal Code:
Graduation Date: Month Day Year (YYYY)

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Release: 8.5.4