Requesting Further Information:

If you would like to be contacted with further information about the CEAS please fill out the form below.

* Denotes Required Field

* First Name:

Middle Name:

* Last Name:

Suffix:

Ethnicity:

Gender:

* Birth Date
(mm/dd/yyyy):

If you are an international student please use Street Address lines 1-4 to enter all mailing information.

* Street Address:

Street Address2:

Street Address3:

Street Address4:

* City:

* State:

* Zip Code:

Phone: (xxx-xxx-xxxx)

* E-mail:

* Expected Date of College Enrollment:

High School Name:

High School GPA:

Desired College Major:

Outreach Participation:

Please check each outreach program in which you have participated.

High School Honors Institute
Engineering Open House
Career Day
Success Institute
Girls Embrace Engineering
Student For A Day
MESA Fall Fling
ITLL Outreach
Please list any other outreach programs in which you have participated.

Comments:

**We do not share our list with anyone outside of the College of Engineering and Applied Science.**

* First Name:
Middle Name:
* Last Name:
Suffix:
Ethnicity:
Gender:
* Birth Date (mm/dd/yyyy):
If you are an international student please use Street Address lines 1-4 to enter all mailing information.
* Street Address:
Street Address2:
Street Address3:
Street Address4:
* City:
* State:
* Zip Code:
Phone: (xxx-xxx-xxxx)
* E-mail:
* Expected Date of College Enrollment:
High School Name:
High School GPA:
Desired College Major: