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Information Request

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First Name:  
Maiden Name:  
Last Name:  
Street Address:  
City:  
State:  
Zip:  
Home Phone:  
Cell Phone:  
Email:  
Date of Birth:  
Gender:  
When do you plan to attend?  
What major are you interested in studying?  
If you are interested in a major not listed here, please request information about our traditional daytime program.
Requested Information:    
 At this time, my interest in Clarke is:  
 I would like someone to:
 
  • Summer School 2015
  • Golf Classic 2015
  • Commencement 2015