Term	Fall 2016
Title	Mr. Ms.
Last Name
First Name
Middle Name
Address 1
Address 2
City
State	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip Code
Country (if not USA)
Home Phone	() -
Bus Phone	() -
E-Mail Address

 Please send me:

	Catalog
	Financial Aid / Scholarship Information
	Information on all four programs of study (Traditional Day, Traditional Evening, PLEAS, SCALE)

 My Primary Program of Interest is (select one):

	Traditional Day brochure (full-time, 3 year program)
	Traditional Evening brochure (part-time, 4 year program)
	PLEAS brochure (part-time, 4 year program for those with childcare responsibilities)
	SCALE brochure (alternative curriculum, 2 year program)