Request for Information Form

Congrats on taking your first step to enroll at Eastern Arizona College!

Thank you for your interest in Eastern Arizona College! Please complete the form below to receive more information.

First Name

Last Name

Birthdate

Contact Information

Email Address

Cell Phone Number

Can we text you at the number listed above?

Yes

No

Mailing Address

Country

Street

City

Region

Postal Code

Education Information

Have you graduating high school or completed your GED?

Yes

No

What year did you graduate from high school or complete your GED?

When are you expected to graduate from your high school?

High School Name

Current School CEEB

Student Type

Entry Term

Interests

Interested Major(s)

Please indicate interest in clubs below. (Select all that apply.)

Please indicate interest in extracurricular programs below. (Select all that apply.)

Please indicate interest in sports below. (Select all that apply.)

Do you plan to pursue sport after high school?

Yes

No

By providing my phone number to Eastern Arizona College (EAC), I agree and acknowledge that EAC may send text messages to my wireless phone number for any purpose. Message and data rates may apply. Message frequency will vary, and you will be able to Opt-out by replying “STOP", assistance can be found by texting "HELP". For more information on how your data will be handled, please visit eac.edu/privacy.