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Information Form for School of Nursing Prospective Students

I am a...
            

            Other:

I am seeking information on...
             (ctrl-click for multiple choices)

I have questions about...
             (ctrl-click for multiple choices)

I would like to...
Have a recruiter call me Set up a campus visit with a recruiter
Have a recruiter e-mail me Have a student ambassador e-mail/call me
Have information mailed to me Tour the school and meet with a student ambassador


About You...
Name:

Address:

City: State: Zip Code:

E-mail Address:

Phone:

Alternate Phone:

Prerequisites Obtained at (College/University):

Date of Expected Entry: