Undergraduate Request for Information

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First Name*

Last Name*

Email Address*

Birthdate*

Country of Citizenship*

Mailing Address*

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Postal Code

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:*

My College is:*

I am interested in:*

Where do you want to attend classes?*

Anticipated UCM date of entry:*

Anticipated Major:*

Are you interested in taking Dual Credit classes with UCM?

Yes

You will receive information about academics, costs, housing and student life. Please indicate if you would like additional information on the following:

Please rate your level of interest in UCM:*

Are you interested in a campus tour?

Yes

Were you referred to UCM by either of the following?

Undergraduate Request for Information

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