Mailing List Request

 

 

 

Fill out the form below to be added to our mailing list and receive information about the university and upcoming events.

 

 First Name: 

 
 

 Last Name: 

  
 

 Mailing Address: 

 
 

 City: 

 
 

State: 

  
 

 Zip Code: 

  
 

 Home Phone: 

  
 

 E-mail Address: 

  
 

Gender: 

 
 
 

 Social Security #(Optional): 

  
 

 High School Name: 

  
 

 High School City: 

  
 

 High School State: 

  
 

 Graduation Year: 

  
 

Area(s) of Interest: 

 

 

 

 

Extracurricular Activities: 

 
      
 
 
 
 
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