Information Request

*Please use Mozilla Firefox or Google Chrome to complete the form below.

 First Name:  
 Maiden Name:  
 Last Name:  
 Street Address:  
 Date of Birth:  
 At Clarke, I have:  
 When do you plan to attend?  
 Requested Information:     

 How did you first learn about Clarke University?
 Check all that apply.

Clarke:   Student   Alum    Employee

If employee, please specify: 

 Employer   Family  Friend  College/Job Fair  Clarke Event

If Clarke Event, please specify: 


 Billboard   Brochure  E-mail   Internet   Mail   Newsletter Newspaper/Insert   Poster  Radio   Television         

Other, please specify: 

  • Spring Visit Day 2015
  • Timesaver 2014
  • Support Clarke - Spring