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Edison State College

 

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Thank you for your interest in Edison State College!

We are pleased you are considering Edison State as an option for continuing your education. Please complete the form below to receive additional information about programs of study, campus locations and other information to help you Discover Your Genius!

This form is not an online admissions application. If you are ready to apply, please go to our online application.

Note: The information you provide to Edison State College is strictly confidential and will never be sold or provided to other agencies.

Required - indicates a required field.
What is your name?
Prefix:
First Name: Required
Middle Name:
Last Name: Required
Suffix:
Nickname:

Where do you live?
Valid From: Month Day Year (YYYY)
Until: Month Day Year (YYYY)
Address Line 1:Required
Address Line 2:
Address Line 3:
City:Required
State or Province:
ZIP or Postal Code:
County:
Nation:
Phone Number: - (xxxxxx)-(xxxxxxxxxxxx) (xxxxxxxxxx extension)
International Access Code:

Information Please provide your primary e-mail address and remember to notify us if it changes. If you do not have an e-mail address or do not wish to create one at this time, please enter “None” in the e-mail address field.

What is your email address?
E-mail Address:Required
Verify E-mail Address:Required

Information Please provide your birth date. By providing this information, Edison State College is better able to avoid duplicate records and fulfill your request for information. Edison State has a strong commitment to ensuring the privacy and confidentiality of student records and will not disclose your personal information without your consent for any purpose except as allowed by law.

What is your birthdate?
Date of Birth:Required Month Day Year (YYYY)

What is your gender?
Gender:Required Male Female Not Specified

When do you plan to attend?
Term of Entry:Required

What would you like to study?
Major:Required

Are you interested in Housing?
Interests:

Information To select multiple items use Ctrl+Click for PC and Command+Click for Mac.

How did you hear about ESC?
How I Learned About Edison State College:

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Release: 8.5.4