Personal Information: To get started, we'll need your basic contact information so we can stay in communication throughout this process.

For July cohorts, please select the corresponding Fall Semester. For January cohorts, please select the corresponding Spring Semester.
First Name

Last Name
 Please use full, legal name.

Prior/Maiden Name

Prefered Name (Nickname)

Social Security Number
 If you do not have a social security number, please leave this field empty. 

Date of Birth

Country of citizenship

Street Address

Address Line 2


State / Province

Postal Code

Preferred Phone Type

Preferred Phone Number

Secondary Phone Type
 Enter Phone Type 

Secondary Phone Number

Email Address

How did you learn about LPU?

    required and     optional