Application Form

Student Name *

Student address *

City *

State *

ZIP/Postal *

Home phone *

Student cell phone *

Student email *

Choose one

Male
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Prospective Major *

Prospective Minor *

T-shirt size *

Do you plan to live in the residence hall for Fall? *

Yes
No

Do you plan to participate in athletics at Lourdes? *

Yes
No

If yes, which sport(s)?

Are you a vegetarian? *

Yes
No

Do you have any dietary restrictions/allergies? *

Yes
No

If yes, details

Why do you want to participate in the ARCHES program? *

What makes you a good candidate for the ARCHES Program? *

What are you most excited about with regard to attending Lourdes University? *

What are some of your personal strengths? *

What are your academic and/or personal concerns about attending Lourdes University? *

If you have a documented disability, please contact the Office of Accessibility Services at Email or 419-824-3523.

By signing this document, you have agreed to participate, to the best of your ability, in the ARCHES Program and committed to attending all assigned Supplemental Instruction labs. Please keep in mind that enrollment in the ARCHES Program is limited, so your timeliness is essential.

Name/Signature *

Date *

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