Request for Information

*Required

Biographical Information

Prefix

First Name*

Middle Name

Last Name*

Birthdate*

Contact Information

Email Address*

Mobile Phone

Would you like to receive text messages from Brescia University?

Yes

No

*By selecting yes, you agree to receive conversational SMS messages from Brescia University, Inc., including appointment reminders, class updates, and support notifications. Msg frequency varies. Msg/data rates may apply. Reply STOP to opt out or HELP for support. See our Privacy Policy and our messaging Terms and Conditions for more information about how we handle your data.

Mailing Address

Country

Street

City

Region

Postal Code

Is your permanent home address different?

Yes

Permanent Address

Country

Street

City

Region

Postal Code

Academic Information

Current School Name

When will you be graduating from your current school?

What term would you like to enroll?

*Are you interested in an online program?

Student Type

Degree Level of Interest

Major

Emphasis

Sports

Current Position

Request for Information - Athletics