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Custom Brochure Request Form
Want to get information about Georgia Southwestern that is personalized to your interests? By completing this form, you will receive an electronic customized brochure sent to your email address on the same day of submission, followed by a hardcopy paper brochure sent to your home address in 7 to 10 days. ( Checked fields are required.)

First Name:
Middle Name:
Last Name:
Preferred Name:
Gender:
Mailing Address:
City: State: Zip:
E-mail Address:
Phone: Date of Birth: (mm/dd/yyyy)
Ethnicity:
Student Type:
Current High School (no abbreviations please):
HS Graduation Year:
Current College (no abbreviations please):
Possible Term of Entry at Southwestern:
Academic Area of Interest:
Student Life Interest:
Student Life Interest:
How did you first learn about Southwestern?
Parent Name:
Parent Email: