Clarke Experience Night | Experience the Roar

Origin Code - HIDDEN

STUDENT INFORMATION

Student Email Address (preferably not a school issued email address)

Student Legal First Name

Student Preferred First Name (if different from Legal First Name)

Student Middle Name

Student Last Name

Student Personal Pronouns

Birthdate

Student Cell Phone Number

Student Other Phone Number

Mailing Address

Country

Street

City

Region

Postal Code

VISIT INFORMATION

Have you visited Clarke prior to this visit?

Parent/Guardian 1

First Name

Last Name

Cell Phone Number

Email

Would you like to add another parent/guardian contact?

Yes

No

Parent/Guardian 2

First Name

Last Name

Cell Phone Number

Email

ACADEMIC INFORMATION

I will be applying as a

When do you plan to start at Clarke?

Current or Last School Attended

Self Reported Cumulative GPA

If you have taken the ACT/SAT, what is the highest composite you have received?

Intended Major

Please select the content area(s) you would like to teach.

Please select the K-8 endorsement area(s) that interest you.

Are you interested in obtaining a coaching endorsement?

Yes

No

Please share with us the subject(s) you are interested in studying.

BSN students are required to have an active CNA when they apply into the nursing major when they are in their second year as an undergraduate.

To be admitted to the clinical hours portion of the nursing major (sophomore level), students must meet the requirements found on our website.
The application to the nursing major is a separate application than the application for admittance that you are filling out now. The nursing major application is sent directly to the student from the Nursing Department. Students must be accepted to Clarke before applying into the nursing major.

Do you have an active CNA?

Yes

No

Planning to take CNA course

Are you interested in a minor?

Yes

No

Please select your minor.

ATHLETIC INFORMATION

Are you interested in playing a sport in college?

Yes

No

Men's or Women's Sport?

Select the primary sport you are interested in playing at Clarke.

MUSIC INFORMATION

Are you interested in participating in choir, band, or strings? (Scholarships available)

Yes

No

Choose all that apply:

Band

Strings

Choir

What instrument(s) do you play?

WRAP UP INFORMATION

Anticipated number of guests (including student)

Please enter the exact number (including student).

Please list any accommodations that you may need (i.e. Spanish interpreter, wheelchair, food allergies, etc.) We will try our best to make proper accommodations for your visit to campus. Please note that we need a 3 week notice for ASL (American Sign Language) interpreters.

Please list any questions you would like answered during your visit.

How did you first learn about Clarke University?

If Other, please indicate where you learned about Clarke University.