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AU Trojan

Traditional Request for More Info

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Your Information

First Name *

Middle Name

Last Name *

Birthdate *

Birthdate *

Email Address *

Mobile Phone Number *

May we send you text messages?

Mailing Address *

Mailing Address *

Country

Street

City

Region

Postal Code

When would you like to start your journey? *

What program would you like to study? *

Parent/Guardian Information

I'd like to enter contact information for my parent/guardian in order for them to receive communication about Anderson University.

I'd like to enter contact information for my parent/guardian in order for them to receive communication about Anderson University.

Yes

No

Relationship to Student

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address

I'd like to enter contact information for another parent/guardian.

I'd like to enter contact information for another parent/guardian.

Yes

No

Relationship to Student

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address