Undergraduate Request for Information

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First Name*

Last Name*

Email Address*

Birthdate*

Country of Citizenship*

Mailing Address*

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Street
City
Region
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Cell phone Number*

Would you like to receive text messages?*

Yes

Student interest type:*

Non-Degree Seeking is designed for students who are seeking professional development, certification/re-certification, taking classes for fun, taking classes for a degree at another institution, or taking classes for non-credit. This student type does not qualify for any financial aid. Which one are you?

High School Graduation Date:*

My High School is:*

Undergraduate Request for Information

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