Agriculture Institute Registration























(including area code)

(including area code)



Disclosure of information protected by privacy laws such as FERPA and GLBA is prohibited.










*Are you Hispanic or Latino?
































List ALL colleges/universities attended or now attending write “none” if you have never attended a college/university
































Do you plan to transfer to a 4 year college or university?






Have you resided in the Lake Land College District for at least the immediate past 30 days?





Are you currently enrolled full time at Eastern Illinois University?