MENU

Information Request

*Please use Mozilla Firefox or Google Chrome to complete the forms below.

 First Name:  
 Middle Name:  
 Last Name:  
 Street Address:  
 City:  
 State:  
 Country:  
 Zip:  
 Home Phone:  
 Cell Phone:  
 Email:  
 Are you a U.S. citizen?  
 Date of Birth:   (mm/dd/yy) 
 Gender:  
 Enrolling As:  
 Enrollment Term:  
What major are you interested in studying?
(If you're not sure, you can submit 'Open')

 

Other: 

 
Which, if any, of Clarke's NAIA Division II varsity athletic teams are you interested in competing?
Men's
     
                                         
Women's
     
 
List the most recent high school you attended, and include the date of graduation or anticipated date of graduation. If you have received your GED in lieu of graduation, please give date.
     Name of High School:  
     City:  
     State:  
     Graduation/GED Date:  
 List the most recent college or university you have attended since high school.
     Name of Institution:  
     City:  
     State:  
     Dates of Attendence:  
 Requested Information:    
 At this time, my interest in Clarke is:  
 I would like someone to:

 
 
  • Fall Visit Days 2014
  • Arts @ Clarke
  • Timesaver