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

By submitting this form, you are providing your express consent authorizing Dominican University and its representatives to contact you by email, text, and phone (including use of an automatic dialing system) at the email and phone number above. Consent is needed to contact you but is not a requirement to enroll at Dominican. Standard text messaging and/or data rates may apply.