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Jackson State Community College

 

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Information Please enter the requested information. Please note that an asterisk denotes required information.

Required - indicates a required field.
Information This information is for students participating in the Jackson State Community College SAILS program. Please complete all information requests as completely as possible.

Prospect Name
Prefix:
First Name: Required
Middle Name:
Last Name: Required
Suffix:
Nickname:

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

Information Providing a valid e-mail address will help us communicate with you.

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

Information This is sample Information text for the ENTRYTERM section. Modify or delete this text by choosing the Customize a Set of Information Text option on the Web Tailor Administration menu and selecting the bwskwpro.P_WebProspectMain procedure.

Prospect Entry Term
Term of Entry:Required

Prospect Birthdate
Date of Birth: Month Day Year (YYYY)

Information We are requesting your SSN so we can match your information to your student file. This information is protected by applicable federal and state privacy laws.

Prospect SSN/TIN/TFN
U.S. Social Security Number: (999999999 or 999-99-9999)

Information This is sample Information text for the CITIZENSHP section. Modify or delete this text by choosing the Customize a Set of Information Text option on the Web Tailor Administration menu and selecting the bwskwpro.P_WebProspectMain procedure.

Prospect Citizenship
Citizenship:Required

Prospect Gender
Gender: Male Female Not Specified

Information This is sample Information text for the ETHNICITY section. Modify or delete this text by choosing the Customize a Set of Information Text option on the Web Tailor Administration menu and selecting the bwskwpro.P_WebProspectMain procedure.

Prospect Ethnicity/Race
Ethnicity:

Note What is your ethnicity?

Hispanic or Latino
Not Hispanic or Latino

Note Select one or more races to indicate what you consider yourself to be.

American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
Alaskan Native
American Indian
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

Caution Please use the LOOK UP HIGH SCHOOL CODE button to search your high school by state and city.

Prospect High School
Home Schooled (check for yes):
OR
High School Code:
High School Name:
Address Line 1:
Address Line 2:
Address Line 3:
City:
State or Province:
ZIP or Postal Code:
Nation:
Graduation Date: Month Day Year (YYYY)
Class Rank and Size: / (must be numeric)
GPA: (example: 9.99, or A+)

Information This is sample Information text for the PRIORCOLL section. Modify or delete this text by choosing the Customize a Set of Information Text option on the Web Tailor Administration menu and selecting the bwskwpro.P_WebProspectMain procedure.

Prospect Prior College
College Code:
Prior College Name:
Address Line 1:
Address Line 2:
Address Line 3:
City:
State or Province:
ZIP or Postal Code:
Nation:
Attended From:
Attended To:
Graduation Date: Month Day Year (YYYY)
GPA: (example: 9.99)
Degree:

Information This is sample Information text for the INTERESTS section. Modify or delete this text by choosing the Customize a Set of Information Text option on the Web Tailor Administration menu and selecting the bwskwpro.P_WebProspectMain procedure.Select the Materials you would like to receive. To select multiple materials use Ctrl+Click for PC and Command+Click for Mac.

Prospect Interests
Interests:

Information This is sample Information text for the MAJOR section. Modify or delete this text by choosing the Customize a Set of Information Text option on the Web Tailor Administration menu and selecting the bwskwpro.P_WebProspectMain procedure.

Prospect Major
Major:

Information This is sample Information text for the HOWILEARND section. Modify or delete this text by choosing the Customize a Set of Information Text option on the Web Tailor Administration menu and selecting the bwskwpro.P_WebProspectMain procedure. Select the Materials you would like to receive. To select multiple materials use Ctrl+Click for PC and Command+Click for Mac.

How Prospect Learned About Us
How I Learned About Jackson State Community College:Jackson State Community College

Information This is sample Information text for the MATERIAL section. Modify or delete this text by choosing the Customize a Set of Information Text option on the Web Tailor Administration menu and selecting the bwskwpro.P_WebProspectMain procedure. Select the Materials you would like to receive. To select multiple materials use Ctrl+Click for PC and Command+Click for Mac.

Requested Material
Request Materials:

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Release: 8.7.2.12