Regional Scholarship Application

URL
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Personal Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone
Home Phone
Email*
High School Information
High School Attending*
Year of Graduation*
ACT Score
Cumulative High School GPA
Are you planning to live on campus?*
- Yes
- No
Do you certify that the information included in this form is true, correct, and complete to the best of your knowledge? By answering yes, you grant Hannibal-LaGrange University the permission to use any and all information provided in this application for any institutional needs deemed necessary.*
- Yes
- No
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Request Info

Phone
This field is for validation purposes and should be left unchanged.
Name*
First Last
Phone*
Email*
Zip*
Campus*
On Campus Area of Study*
Online Area of Study*
Consent
By submitting this form, I consent to Hannibal-Lagrange University contacting me by phone for marketing messages (including mobile and manual/autodialed means) and email using the information I have provided. I understand that my consent is not a condition of enrollment.
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Personal Information