Dean College Information Request

* I will be a:

First-Year Student

Transfer Student

I plan to study:

Full-Time

Part-Time

* Email Address

* First/Given Name

* Last/Family Name

Preferred First Name
Use of Preferred Name

* Birthdate

* Primary Citizenship

Mobile Phone (xxx-xxx-xxxx)

Home Phone (xxx-xxx-xxxx)

* Mailing Address

Country

Street

City

Region

Postal Code

High School (or College for Transfer Students)

High School Graduation Year

* Entry Term

*Please select up to three choices for your Academic Interest.

(To select multiple interests please ctrl-click each item.)

I am interested in learning about the Arch Learning Community for students with diagnosed learning differences.

Yes

Would you like to share information about your family?

Yes

Relationship

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address

Are you interested in playing an NCAA Division III sport?

Yes

Sex

Male

Female

My first choice sport is:

My second choice sport is:

How did you first hear about Dean College?

Please provide additional details.

Preferred method of contact.

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Any additional comments or questions: