Information Request Form Galveston - International Transfer
* Indicates a required field or an issue in the form.
Please complete using your full legal name as it appears on your birth certificate or passport.
First/Given Name:* Last/Family Name:*
Middle Name:

Address Line 1:* Address Line 2:
Zip: Nation:*
Phone Number: -
Format of Domestic Numbers: "Example: 979-5555555"

International Numbers: Enter your country code and international access code in the first space provided
and your phone number with no hyphens in the second. Example: "01144-8735555555"

Verify E-mail:*


Nation of Citizenship: Nation of Birth:

Date of Birth:*
Year (YYYY)

Gender: Male    Female

Term of Entry:* Major:

Home Schooled: Yes


High School Code:
HS Grad Year: (YYYY)

College Code:
Graduation Year: (YYYY)


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