Information Request Form

First Name

Middle Initial

Last Name

Suffix

Date of Birth

Preferred Communication Method

Phone

Address

City

State/Province

Zip

Country

Applicant Type

Projected Quarter Start

Projected Year Start

Intended Field of Study

In order to provide you with the best information possible, please fill out the applicable information below:

Educational Goal

Current School Attending

Gender

Ethnicity

Ethnicity Other (please specify)

Are you a veteran or active duty?

Are you the first in your family to attend college?

Visa Type

Current Employer

How did you hear about us?

Would you like information on the following? Check all that apply.

Admissions
Assessment Test
Athletics
Campus Visits

eLearning
Financial Aid/Scholarships
Running Start
Student Life and Activities

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