Request Information

In order for us to appropriately respond to your inquiry, please provide the following information. To assure accuracy and to avoid unwanted duplicates, please use the appropriate capitalization in all fields. For instance, capitalize the first letter of names and street names, etc. Do not type in all capital letters.

Salutation: Ms. Mrs. Mr. Dr.

*First	Middle	*Last/Surname

*Email Address	*Confirm Email Address

*Gender:	Birth Date (mm/dd/yyyy)
Male Female


Mailing Address
Country:
Street Address 1:
Street Address 2:
City:
State/Province:
Zip/Postal Code:

Phone Number - Domestic

Home: ( ) - Cell: ( ) -

Phone Number - International
Country Code Country Code
Home: Cell:

I am interested in the following semester (term):

2010 Spring	2010 Summer	2010 Fall	2011 Spring
2011 Summer	2011 Fall

I am interested in the following programs:
You may choose up to 5 programs along with their corresponding plans and/or sub plans. Plans and sub plans will be displayed after selecting an item from the previous column's pull-down menu. A minimum of only one program selection is required.

Academic Program	Academic Plan	Academic Sub Plan

Optional Information:
The latest degree I earned OR the current degree I am in the process of completing is:

Country

State

University name

Date or anticipated date of completion (mm/dd/yyyy)

If your institution is not listed, please email information@cgu.edu.

It would be helpful for me to have additional information about:

I first learned about CGU's academic program from:

Speaking to an admission advisor
Speaking to a current student
Parking information
Sitting in on a class
Things to do around campus
Housing
Financial aid

I am interested in attending the following information session on CGU's campus:

Session:

If you can't attend one of our scheduled sessions, we would be happy to meet with you at a time that is more convenient for you. Please request a date by emailing information@cgu.edu or calling us at (909)607-3689.

Student Services � Office of Admissions � Weekdays 8:30 - 5:00 � Mailing Address: 160 East Tenth Street, Claremont, CA 91711
Phone (909) 621-8069 � Fax (909) 607-7285 � Email: admiss@cgu.edu