Jenzabar University

Culver-Stockton College Inquiry Form

Thank you for your interest in Culver-Stockton College.  To request further information about Culver-Stockton College, please select the type of student you would be when entering C-SC.

I am requesting information for:

PERSONAL INFORMATION

Required information is marked with a * (red asterisk) and must be completed before the form will submit.  If any required information is not applicable to you, enter N/A.

Prefix

First Name

Middle Name

Last Name

Preferred Name

CITIZENSHIP INFORMATION

What is your citizenship status?

If not US citizen, citizen of

BIOGRAPHICAL INFORMATION

Gender

Birth Date

ENROLLMENT INFORMATION

Entering Year

Entering Semester:

Anticipated Major

WILL YOU BE PARTICIPATING IN COLLEGIATE ATHLETICS?

Please select your athletic primary interest: 

WILL YOU BE PARTICIPATING IN COLLEGIATE FINE ARTS?

Please indicate Fine Arts primary area of interest: 

HIGH SCHOOL INFORMATION

Type of High School

State of Institution

Select mailing address city of institution

Institution

Name of Institution

Year of Graduation 

High School GPA

On a scale of

Home School/GED Anticipated Completion Year

ACT/SAT

Have you taken the ACT or SAT?

Score on ACT/SAT?

CONTACT INFORMATION

Do you reside in the United States?

All address information is required.  Entering the zip code should populate the city and state.  If any information is pre-populated, please make changes as needed.  

Enter any additional address information such as Province, Region, Postal Code, etc. required for international addresses in the Additional Address field.  Separate additional information with commas.

Address Line 1

Address Line 2

Additional Address

Zip Code

City

State

County 

Country

Cell Phone

International Phone Number

Email Address

Confirm Email Address

Parent Email Address

Please review and answer the following statements regarding collection of data by Culver-Stockton College.

Culver-Stockton College may communicate with me by mail, email, phone, or text message prior to or after submission of my application or inquiry.  You may withdraw consent by sending a notice to webmaster@culver.edu.

I understand and consent that all data collected will be used as specified in the Culver-Stockton College Privacy Policy.

By checking this box, I represent that (i) I am age 18 or older and (ii) I have read, understood and agreed to the terms and conditions of the  Privacy Policy (unless I am under the age of 18, in which case, my parent or legal guardian has also read, understood and agreed to the terms and conditions of the Privacy Policy).

SUBMIT INQUIRY

Please check your completed form for all required information.  Required questions are preceded by a red *.  Your request form will not submit if required questions are not completed.  

If you have completed all information, click the Submit Inquiry button to submit to the Admission Office.