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United States Citizens only, please complete the following information to help us better serve you.  After you have entered the requested information, please click the "Submit the Request" button. 

If you are an international student (not a United States citizen) please use the International Student Admission Information Request Form instead of this form.  Using the form below will delay the processing for international students.

Maiden Name (if applicable):
Birthdate: (MM/DD/YYYY)
Street Address:
Zip Code:
Phone Number:
E-mail Address:
Have you previously attended USA?
Yes No
Educational Level:

When do you plan to attend?

If you are currently enrolled in a high school or college, please list the name of the institution, city, state:

Do you have any questions or comments?


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University of South Alabama - Mobile, Alabama 36688-0002 (251) 460-6101
For questions or comments Contact Us
Date last changed: Tuesday, August 13, 2013 10:15 AM
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