#ExperienceLR

Student Information

First Name

Preferred First Name

Last Name

Pronouns

Birthdate

Select the one that best describes you.
Please note that any student who has not yet received a high school diploma will qualify as a first-year student.

When are you planning to enroll at LR?

What is your academic interest?

If you are undeclared, please indicate the classroom experience session you'd prefer to attend:

Student Contact Information

Email Address

Cell Phone Number

Lenoir-Rhyne may message me via my cell phone so I don’t miss out on important information.

Yes

No

Home Phone Number

Mailing Address

Country

Street

City

Region

Postal Code

Would you like to add parent contact information?

Yes

No

Parent / Guardian Contact Information

Relationship Type

First Name

Last Name

Email Address

Phone Number

Event Information

How many guests will be joining you at #ExperienceLR?

Will you or any of your guests need mobility accommodations (i.e. golf cart transportation)?

Yes

No

I hereby grant Lenoir-Rhyne University permission to use my likeness in a photograph, video, or other digital media in any and all of its publications, including web-based publications, without payment or other consideration.

Yes

No