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New Student Questionnaire

*Last Name: *First Name:
Street Address:
City:  State:
*Mailing Address:
*City: *State:
Home Phone: Cell Phone:

Emergency Contacts

Please include a phone number in addition to your home phone where we can reach someone in case of an emergency.

Contact #1 Contact #2
*Name: Name:
Address: Address:
City: City:
State:    Zip:  State:    Zip: 
*Phone: Phone:

Personal Information

Please tell us about yourself.

Entrance Status:  Freshman Transfer
Date of Birth:  (mm/dd/yyyy)
Sex:   Male Female
Will you register a
vehicle on campus?
Yes   No
I live with: Mother & Father  Mother    Father  
Other Relatives   Other
My family includes:  Brothers   Sisters
My home is in an: Urban   Suburban    Rural setting
Leadership: Were you involved with leadership during high school?
   Yes   No
  If "Yes" please tell us more. If "No" proceed to the Personal Development section.
  Student government/student council/class council
Student Clubs - If checked please list clubs below:

Service Organization - If checked please list organization names below:

How were you involved?

Do you plan to be involved while attending Franklin Pierce University?

Personal Development

Please select any item/issue, which you would like to address as you enter your first year of college.

Adjustment to college Eating Patterns Sexuality
Alcohol and Other Drugs Effective Coping Strategies Stress and Anxiety Issues
Assertiveness Family Issues Surviving Violence
Body Image Gaining Personal Independence Understanding Self
Building Self-Esteem Improving Relationships Women’s Issues
Death and Dying Interpersonal Communication    
Decision Making Men’s Issues    

Personal Interests

A variety of clubs, organizations and activities are available to students. Please check those in which you may have an interest. You will be contacted by club leaders or department concerning organized meetings.

  Sports   Social and Educational   Public Services
Basketball (Men's) Ecology Club EMS/Fire Department
Basketball (Woman's) AGAPE FP TV
Baseball Anime Pierce Arrow (newspaper)
Cheerleading Anthropology Club Student Alumni Volunteers
Crew (Men's) Black Student Alliance WFP Radio
Crew (Woman's) BRO (Brothers Reaching Out) Yearbook
Cross Country (Men's) Democrats Pierce Activity Council (PAC)
Cross Country (Woman's) Gamers Club    
Field Hockey GSA (Gay/Straight Alliance)   Student Government
Golf Graphic Design Club Judicial Board
Ice Hockey Hillel (Jewish Alliance) Res Hall Association
Lacrosse (Men's) Honors Program Student Senate
Lacrosse (Woman's) International Club    
Soccer (Men's) Invisible Children   Recreational
Soccer (Woman's) Law Adventure Recreation
Softball Medical Club Intramural Sports
Tennis (Men's) Psychology Club Rugby (Men's)
Tennis (Woman's) Raven Thunder (dance) Rugby (Women's)
Volleyball Republicans Sailing
Sports and Recreation Sci-Fi Fitness/Wellness Classes
    Students for Sensible Drug Policy   Other
    Study Abroad Alternate Break Programs
    Underground Cinema Campus Ministry Program/Retreats
    Education Club Leadership Development Ed
        Volunteer/Community Service