Information Request Form

Required fields *

Is this a: *Update       Cancel     ID #        New  
* Campus:   * Date:
* Program of Interest::   UG or  GR  * Program name:
* When do you want to start? Year:
Number of previous college credits :  
*Last Name * First Name: Middle Name
* Address:  
* City:   * State: * Zip:
Phone: (Primary) Phone: (secondary) Email:
* What is the best time to contact you? *Gender:  
____________________________________________________________________________________________________________
* How did you hear about Chapman University (please check the box below)?
Yellow Pages Other college/university (which one)
Place of Employment Promotional Mailing (which one)
Former Student Television (which station)
Current Student Newspaper (which one)
Faculty Member Radio (which station)
Program Manager College/Recruitment Fair (Which one)
Internet Search
Have you previously inquired to CUC:       Yes
_____________________________________________________________________________________________________________
For Campus Staff Use Only:

Rate the applicant's interest in attending Chapman University College:

*Recruiter Datatel ID

Notes:

* Source of Contact:
XXXISA – Info Session  Date :*
XXXWK – Walk-in
XXXT – Telephone
Other – Code
 
     
* Submitted by: * Email:  

Revision 05/23/08