Request For Information

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Origin Code - Hidden Field

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First Name *

Last Name *

Maiden / Alternate Last Name

Preferred First Name

Email Address *

Birthdate *

Primary Phone *

Is this a mobile phone? *

Yes

Mailing Address
Country
Street Address
City
Region
Postal Code

Mailing Address *
Country
Street Address
City
Region
Postal Code

Primary Language

Major / Program *

Program Type *

Program Option *

School District *

Expected Undergraduate Graduation Date*

Indicate the course(s) you have interest in

Term *

Term **

Last school attended

HS grad date *

Athletic interest

Yes

Type

Men's

Women's

Sport of interest

Enter an additional sport?

Yes

Additional Sport of interest

Other interest

Additional Information for Collegiate Activity

You selected 'Other' from the Collegiate activity menu. Please provide more detail here.

Please indicate the instrument(s) you play.

Please indicate the intramural sport you play.

Enter additional interests?

Yes

Additional interest

Additional Information for Collegiate Activity

You selected 'Other' from the Collegiate activity menu. Please provide more detail here.

Please indicate the instrument(s) you play.

Please indicate the intramural sport you play.

Additional Requested Information

Clarke University information packets include general information. Please indicate below if you have any specific question(s) for your personal admissions counselor.