Hometown Information form

Lakeview College of Nursing uses software to publicize student achievements and activities on campus -- like making the dean's list, participating in student government, or winning a scholarship. Personalized stories about these accomplishments are published in an online profile and they are sent to hometown newspapers. These stories also often appear on Lakeview's website and Facebook page. For more information on how this process works please go to the accomplishments page. Please complete the information below so that we can share your good news appropriately.

Last name:

First name:

Middle name:

E-mail address:

Gender:

Male

Female

Hometown

City:

State:

ZIP code:

High school education

Name of school:

City:

State:

Graduation year:

College education

Name of school:

City:

State:

Graduation year:

Parent 1

Last name:

First name:

Middle name:

E-mail address:

City:

State:

ZIP code:

Parent 2

Last name:

First name:

Middle name:

E-mail address:

City:

State:

ZIP code:

Parents should be listed:

together

separately

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Hometown Information form

Hometown

High school education

College education

Parent 1

Parent 2