1.	Name:*

2.	Preferred First Name (Nickname):

3.	Title (Dr. Mr. Mrs., etc.):

4.	Sex:

5.	Street Address:*

6.	City, State, Zip:*

7.	Telephone:

8.	E-Mail:

9.	Relation to Prospective Student (parent, step-parent, etc.):

10.	How would you prefer to receive information about W&J? (please check all that apply)*
	Email Mail Correspondence Social Media If so, what type? (facebook, twitter, etc.)

11.	How helpful would it be to hear from the following members of the college community during the college search process?*
	Not Helpful   Somewhat Helpful   Helpful   Very Helpful Faculty/Staff         Students         Alumni         Parents of Current Students