Undergraduate Programs Information Request

Personal Information

First Name

Last Name

Email Address (personal, non-school email address)

Cell Phone

Date of Birth (collected to prevent the creation of duplicate records)

Academic Program

I will be applying as a:

I am interested in studying:

I plan to start classes in:

High School Information

Last High School Attended

Unable to find your school?

If you were home-schooled, select Home School
If you completed a high school equivalency exam (e.g., GED, HiSET, TASC), select HS Equivalency
If you cannot find your school, select Unlisted High School

School CEEB Code

School Information

Last College/University Attended

Unable to find your school?

If you cannot find your school, select Unlisted College

School CEEB Code

Text Messaging

By submitting this form, I understand that Dominican University will use this information to contact me. We respect your privacy and will not share your contact information with anyone. Data rates may apply.