Request for Information

Which best describes you?

Please complete this form using your own information. Additional notes can be added by choosing "Other" for the last question on the form.

If other, please describe

Primary Campus of Interest

First Name

Preferred Name

Last Name

Date of Birth

mm/dd/yyyy

Email Address

How would you like for us to communicate with you?

Phone

###-###-####

Primary Phone Type

Primary Phone

###-###-####

Do you live in the United States?

YesNo

Address

Street Address

Please do not use abbreviations.

City

State

Zip Code

Interested Students

Which best describes your high school experience?

Expected High School Grad Month

Expected High School Grad Year

Please enter year between 2001-2099.

Are you homeschooled?

Homeschooled students complete education requirements in a home setting and do not receive a diploma from a local public or private school or Indiana Department of Education.

High School State

High School City

Official Full Name of High School (No Abbreviations)

Anticipated College Start Month

Anticipated College Start Year

Field of Interest

If you have more than one interest, please submit separate forms.

FieldofInterestID

What information are you looking for?

If other, please describe.

By submitting this form, I agree to receive information via phone, text message, and/or email to the contact information provided.

I agree

Hidden - Recruiter

RFI Lead Source

Referring Campus

Recruiter User ID

Hidden - Analytics

UTM Code

utm_source

utm_medium

utm_campaign

utm_term

utm_content

gclid

Analytics clientID

WRA

WRT