Advanced Technological Education
College Park Building, Room 141
Ph: 372-29676
Fax: 372-8667
Contact: Sherri Orwick
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Advanced Technological Education               Prospect Information Form
College Park Building, Room 141                  ...
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Prospect information form blank

  1. 1. Advanced Technological Education College Park Building, Room 141 Ph: 372-29676 Fax: 372-8667 Contact: Sherri Orwick Prospect Information Form (PIF) Primary Information Last Name: ____________________________ Initial Contact Date: __________ First Name: _________________ M. Initial: _______ Address: ___________________________________________________________________ City: __________________ ST: ______ Zip:_______ E-mail: ______________________ Home Ph: ________________ Work Ph: ________________ Cell Ph: ________________ Associate Degree? Y N Year: ______ Major: ____________________________ Institution: _________________________________ Accredited when attended? Y N Other Degree: ______________________ Institution:_____________________________ Other Institutions: ___________________________________________________________ Worked full time for 12 consecutive months? Y N Occupation:_____________________ Position/Title: ___________________________ Company: _______________________ Referred by: BGSU Website _______________ College __________________________ Mailing _____________________ Other __________________________ Approx. Date: ________________ Resolution Information Perform Unofficial Audit? Y N Date: __________________________ Recommended BLS? Y N Reason: ________________________________________ Date to Adult Learning: ___________________________ Recommend Firelands or other College? Y N Reason: __________________________ Eligible for ATE? Y N Reason: ________________________________________ Admission Application Date: ________________ Official Transcripts Requested: Y N Date prospect was informed: ________________ by: ___________via: ______________
  2. 2. Advanced Technological Education Prospect Information Form College Park Building, Room 141 Page 2 of 2 Ph: 372-29676 Fax: 372-8667 Contact: Sherri Orwick Notes __________________________________________________________________________ _ __________________________________________________________________________ _ __________________________________________________________________________ _ __________________________________________________________________________ _ __________________________________________________________________________ _ __________________________________________________________________________ _ __________________________________________________________________________ _ __________________________________________________________________________ _ __________________________________________________________________________ _ __________________________________________________________________________ _ __________________________________________________________________________ _ __________________________________________________________________________ _
  3. 3. __________________________________________________________________________ _ __________________________________________________________________________ _ __________________________________________________________________________ _ __________________________________________________________________________ _ __________________________________________________________________________ _ __________________________________________________________________________ _ __________________________________________________________________________ _

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