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Inquiry Form Reg B - Staff Input
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
January
February
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2012
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1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Assigned Birth Sex *
Assigned Birth Sex *
Female
Male
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
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
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 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
High School Information
High School Graduation Year *
2024
2025
2026
2027
2028
2029
Graduated
High School Name (Please start typing the name and then select the auto complete option.)
High School Code
High School GPA * (Unweighted)
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)
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