*First Name  MI  *Last Name

Street Address 

*City   *State *Zip Code


*Registration Type

If Student, please fill out the following info:

* School

* Grade  Note: PLEASE only enter the grade number

Will your Parent/Guardian be attending as well

Enter in your potential College choices below (enter in ONE college per line)


How did you find out about College Prep 101

If a you were referred by a member of Omega Psi Phi Fraternity, Inc. or Delta Sigma Theta Sorority, Inc. , please tell us his/her name

If Other, please tell us


If you have any additional questions, email