* First Name
* Last Name
* Daytime Phone
* Evening Phone
* Email
* Street
* City
* State
* Zip
* Best Time to Call
* High School Grad Year
* Education Level
* Preferred Location
* Program of Interest
* When do you plan to begin?
* Age
* Are you an active/former U.S. military member? Yes / No
* Are you currently employed? Yes / No
* Are you a U.S. citizen? Yes / No