Stark State Survey for Students

First Name:
Last Name:
Street Address:
City:
State:
Zip Code:
Email Address:
Gender:
Male
Female
Full or Part Time:
Full Time
Part Time
Number of Credit Hours (min. of one):
Anticipated Graduation Date:
Previous Colleges Attended:
Current Degrees Held (choose all that apply): BA
BS
MA
MEd
Other
What Academic Program are you Enrolled in (choose only one):
Business
Engineering
General Studies
Health
Age (for demographic purposes only):
N/A
< 21
21-30
31-40
41-50
> 50
Would You Like Further Information:
Admission Application
Class Schedule
Financial Aid Kit
Catalog
Would you like to be added the the mailing list:
Yes
Comments: