Student Information Form
Last Name:
First Name:
Address 1:
Address 2:
City:
State
:
Zip Code:
Phone Number:
Class Preference:
Day
Evenings
Weekends
Days You Can Be On Campus:
M
T
W
R
F
S
Major of Interest:
CIS
BCIS
NCOM
Type of Degree:
Associates Degree
Bachelors Degree
Comments: