2019 NSE WHT Demographic Sheet
William H. Thompson Scholar
New Student Enrollment Survey
For Department Use Only
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First *
Middle *
Last *
Nuid *
T-Shirt Size (the shirts run small) *
Gender
Clear selection
Race/Ethnicity (Check all that apply) *
Required
Are you a First Generation Student? *
First generation students are the first in their family to attend and receive a 4-year college degree at a recognized institution in the United States.
Date of Birth *
MM
/
DD
/
YYYY
High School *
City *
Major (if known) *
College (if known) *
Some examples: College of Business, CASNR, Arts & Sciences
Student's Email *
Student's Cell Phone Number *
Permanent Home Street Address *
City *
State *
Zip Code *
Parent/Legal Guardian First Name *
Parent/Legal Guardian Last Name *
Parent/Legal Guardian Relationship *
Examples: Mother, Father, Caseworker, Uncle, Grandmother
Parent/Legal Guardian Phone Number *
Housing *
If you are living in the Residence Halls, what is your hall and room number?
What is your roommate's name and are they a Thompson Scholar (if known)
If you are living elsewhere, what is the address?
Who are you living with?
Clear selection
Please list all allergies you have. (If none, please enter "None") *
Please list all medications you are taking. (If none, please enter "None") *
WHT can provide assistance in supporting your mental and emotional wellness. Please indicate if this is something you would be interested in using. *
Do you have a care provider in the Lincoln area? If yes, please provide their information. If no, please enter "No". *
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