Evening Degree Program
Information Request Form, US Residents
Mail Evening Degree catalog and application to me
Contact me to schedule an advising appointment
First Name *
Middle Initial
Last Name *
E-mail *
Phone (with area code) **
Street Address (including
apartment number) *
City *
State *
Select State
Alaska
Alabama
Arkansas
American Samoa
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Guam
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Marshall Islands
Michigan
Minnesota
Missouri
Northern Mariana Islands
Mississippi
Montana
Nebraska
North Carolina
North Dakota
Nevada
New Hampshire
New Jersey
New Mexico
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Palau
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Virgin Islands
Vermont
Washington
West Virginia
Wisconsin
Wyoming
ZIP Code *
Country
This form is for U.S. citizens and resident non-citizens.
Outside US please click here
What college have you attended most recently?
Choose One
Bellevue Community College
Big Bend Community College
Central Washington University
Centralia College
City University
Clark College
Columbia Basin Community College
Cornish Coll of the Arts
Eastern Washington University
Edmonds Community College
Everett Community College
Evergreen State College
Gonzaga University
Grays Harbor College
Green River Community College
Griffin College
Highline Community College
Lake Washington Tech College
Lower Columbia College
North Seattle Community College
Northwest College
Olympic College
Pacific Lutheran University
Peninsula College
Pierce College
Renton Technical College
Seattle Central Community College
Seattle Pacific University
Seattle University
Shoreline Community College
Skagit Valley College
South Puget Sound Community College
South Seattle Community College
Spokane Community College
Spokane Falls Community College
St Martins College
Tacoma Community College
University of Puget Sound
University of Washington
Walla Walla Community College
Walla Walla College
Washington State University
Wenatchee Valley College
Western Washington University
Whatcom Community College
Whitman College
Whitworth College
Yakima Valley Community College
If your school is not in the list above
please enter the school name in the text box below and the 4 digit College Board code if known (
The College Board website
has a list of most schools and their codes).
Name of College:
4 Digit Code:
What is your grade level/class?
Select one
Sophomore
Junior
Senior
Other/Not sure
Degree Earned:
Select one
AA
AAS
BA
BS
Other
None
When do you plan to enroll? *
Select a Quarter
Fall 2009
Winter 2010
Spring 2010
Summer 2010
Fall 2010
Winter 2011
Spring 2011
Summer 2011
Which major are you interested in? *
Select Major
Communication
English
Humanities
Health Information Administration
Social Sciences
Other/Unknown
*
Required field
**
Required if "
Contact me to to schedule an advising appointment
" is checked
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