Department of Residential Life
New Student Questionnaire

Last Name:

First Name:

MI:

Address:

City:

State:

Zip:

Mailing Address:

City:

State:

Zip:

Home Telephone:

Emergency Contact:
Must have a phone number in addition to your home phone where we can reach someone in case of an emergency.

Contact #1:		Contact #2:
Name:		Name:
Street:		Street:
City:		City:
State:		State:
Zip:		Zip:
Phone:		Phone:

Entrance Status: Freshman Transfer

Date of Birth: Format: mm/dd/yyyy

Sex: MaleFemale

Will you register a vehicle on campus?

Personal Information

I live with: Mother & Father Mother Father Other Relatives Other

My family consists of: Brothers Sisters

My home is in an: Urban Suburban Rural

Leadership:

Were you involved with leadership during high school? YES NO

If "YES" please tell us more; If " NO" proceed to PERSONAL DEVELOPMENT SECTION.

Student government/student council/class council
Student Clubs - If checked please list clubs below:

Athletics/Intramurals
Yearbook
Chorus/Band
Service Organization - If checked please list organization names below:

How were you involved?
Member
Treasurer
Officer
Volunteer

Do you plan to be involved while attending Franklin Pierce University?
Yes
No
Undecided

PERSONAL DEVELOPMENT ACTIVITIES

Please select any item/issue, which you would like to address as you enter your first year of college.

PERSONAL INTERESTS

A variety of clubs, organizations and activities are available to students. Please check those in which you may have an interest. You will be contacted by club leaders or department concerning organized meetings.

Department of Residential Life New Student Questionnaire

Department of Residential Life
New Student Questionnaire