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Request Information Form
Tell us more about yourself
Please fill out the fields below and submit the form. Some information is required and marked with asterisks (*).
We value your privacy. This information is used to personalize your Berea College experience and will not be sold to any third party.
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Basic Information
First Name *
Preferred Name
Last Name *
Date of Birth *
Date of Birth *
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1912
1911
1910
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1908
1907
1906
1905
1904
1903
1902
1901
1900
Gender Identity
Gender Identity
Agender
Genderfluid
Genderqueer
Intersex
Man or Male
My identity is not listed
Non-Binary
Trans Man
Trans Woman
Woman or Female
Assigned Birth Sex *
Assigned Birth Sex *
Female
Male
Pronoun Preference
Pronoun Preference
he/him/his
she/her/hers
they/them/theirs
Are you of either Hispanic and/or Latino descent?
Are you of either Hispanic and/or Latino descent?
Yes
No
Ethnicity
Ethnicity
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific
White
Please choose which option best describes you.
Please choose which option best describes you.
U.S. Citizen or eligible non-citizen (e.g. permanent resident/refugee/asylee/DACA)
International student (F-1 / J-1) not holding citizenship in the United States
Contact Information
Email Address *
Cell Phone
May we use your cell number to send occasional text messages?
May we use your cell number to send occasional text messages?
Yes
No
Home Phone (If Different)
Home Address *
Home Address *
Country
Street
City
Region
Postal Code
Is your mailing address different than your home address?
Is your mailing address different than your home address?
Yes
No
Mailing Address
Mailing Address
Country
Street
City
Region
Postal Code
Are you a transfer student? *
Are you a transfer student? *
Yes
No
High School Information
High School Graduation Year *
2025
2026
2027
2028
Graduated
High School Name (Please start typing the name and then select the auto complete option.)
High School Code
Graduate
High School
Undergraduate
High School GPA * (Unweighted)
College Information
College Name (Please start typing the name and then select the auto complete option.)
College Code
College School Level
College School Level
Graduate
High School
Undergraduate
Personalize Your Experience
Do you have a few minutes to tell us more about yourself?
Do you have a few minutes to tell us more about yourself?
Yes
No
Will you be the first in your immediate family to graduate college?
Will you be the first in your immediate family to graduate college?
Yes
No
Family Information
Parent/Guardian First Name
Parent/Guardian Last Name
Relationship to you:
Father
Grandfather
Grandmother
Legal Guardian
Mother
Other Relative
Parent
Step-Father
Step-Mother
Parent/Guardian Email
Academic Information
ACT Composite
SAT Total
Academic Interests
Select as many academic interests you would like. To do so, hold down the control key when making your selections.
Academic Interests *
Asian Studies
Asian Studies - Chinese Studies
Asian Studies - Comparative Asia
Asian Studies - Japanese Studies
Accounting
Business Administration
Economics
Economics - International Politics and Policy
Finance
Management
Marketing
Broadcast Journalism
Communication
Digital Media
Film and Video Studies
Film Production
Art History
Studio Art
French
Spanish
Health and Human Performance
Health Studies
Neuroscience
Nursing
Nutrition and Food Studies
Outdoor Education and Recreation
Pre-Dental
Pre-Medicine
Pre-Pharmacy
Pre-Veterinary Medicine
African and African American Studies
Anthropological Archaeology
Appalachian Studies
Child and Family Studies
Child Development
Community and Civic Engagement
Creative Writing
Education Studies
English
History
Law, Ethics and Society
Peace and Social Justice Studies
Philosophy
Political Science
Pre-Law
Psychology
Sociology
Studies of Religions and Spirituality
Women's, Gender and Sexuality Studies
Dance
Music
Musical Theatre
Theatre
Agriculture and Natural Resources
Biochemistry
Biology
Biomedical Sciences
Chemistry
Computer and Information Science
Engineering Physics
Engineering Technologies and Applied Design
Environmental Science
Forest Resources Management
Geology
Mathematics
Physics
Pre-Engineering
Sustainability and Environmental Studies
Technology Management
Teacher Certification - Biology (grades 8-12)
Teacher Certification - Chemistry (grades 8-12)
Teacher Certification - Elementary Education (grades K-5)
Teacher Certification - English (grades 8-12)
Teacher Certification - Mathematics (grades 8-12)
Teacher Certification - Middle Grades Mathematics (grades 5-9)
Teacher Certification - Middle Grades Science (grades 5-9)
Teacher Certification - Music Instrumental Emphasis (grades K-12)
Teacher Certification - Music Vocal Emphasis (grades K-12)
Teacher Certification - Physical Education and Health (grades K-12)
Teacher Certification - Physics (grades 8-12)
Teacher Certification - Social Studies (grades 8-12)
Cocurricular and Extracurricular Interests
Select as many cocurricular and extracurricular interests you would like. To do so, hold down the control key when making your selections.
Interests
Appalachian Traditions
Art
Broadcasting
Career Preparation
Creative Writing
Dance
Drama/Theatre
Entrepreneurship
eSports
First-Gen Resources
Health and Fitness
Honor Societies
Intercollegiate Athletics (NCAA III)
International and Cultural Organizations
Internships
Intramural Sports
LGBTQIA
Literature
Music
Non-Trad Student Resources
Outdoor Recreation
Photography
Religious Fellowship
Robotics
Service Learning/Organizations
Social Justice
Speech/Debate
Student Leadership
Study Abroad
Sustainability
Undergraduate Research
Intercollegiate Athletics
Cheer
Men's Baseball
Men's Basketball
Men's Cross Country
Men's Golf
Men's Soccer
Men's Tennis
Men's Track & Field
Women's Basketball
Women's Cross Country
Women's Soccer
Women's Softball
Women's Tennis
Women's Track & Field
Women's Volleyball
Outdoor Recreation Activities
Canoeing
Caving
Fishing
Hiking
Kayaking
Rock Climbing
Skiing
Study Abroad Locations
Africa
Asia
Australia
Central America
Europe
Middle East
South America
Religious Fellowship Groups
Awakening Ministries
Campus Crusade for Christ
Catholic Newman Club
Episcopal Canterbury Fellowship
InterVarsity Christian Fellowship
Muslim Student Association
Pagan Coalition
Secular Students of Berea
Dance Groups
Artists in Modern Motion
Country Dancers
EYCE Step Team
FYAH Hip Hop Dance Team
Middle Eastern Dance Ensemble
Sazon Latino
South Asian Fusion Dance Team
Swing Dance Club
International and Cultural Organizations
African Student Association
Appalachian Student Union
Arab Student Association
Asian Student Union
Black Student Union
Cosmopolitan Club
Latin American Student Union
Sisterhood of Queens United Among Diasporas (SQUAD)
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