Clark State College Interest Form

Thank you for your interest in Clark State!

Please complete the form below to join our mailing list and learn more about what Clark State can offer you. Fields with a red * are required.

First Name

Preferred Name (If different than your First Name above)

Middle Name

Last Name

Birthdate

Email Address

Mailing Address

Country

Street

City

Region

Postal Code

Cell Phone number

Home Phone Number

May we text you?

Yes

No

Are you currently attending high school?

Yes

No

Are you interested in the College Credit Plus program?

Yes

No

Please type the city and state where you attended or are attending high school, for example, Springfield, OH or Spr***, OH and then choose from the list. GED recipients should type GED instead of a city and state.

CEEB Code (hidden)

When did you / will you graduate from high school or obtain your GED?

What field are you interested in?

Are there specific programs you are interested in? If you are using a keyboard, you can choose multiple by holding down your Ctrl key. On a mobile device, your can choose multiple by clicking on the buttons.

What semester do you hope to start?

Are you interested in sports? If yes, please select the sport(s) below.

I'm interested in attending classes in:

Where did you hear about Clark State? You can select more than one by holding down your Ctrl key.