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Request Information

If you would like to receive information about Clark State, we will mail you a viewbook with selected program information and a printed copy of the latest course schedule for the upcoming quarter.

Please complete the following form including your full postal mail address. A full postal address must be provided to process your request for a viewbook.

If you have problems sending this request, do not receive a response within a week or have additional questions, please call the Admissi ons Office at 937/328-6028 for assistance.

Name:
Address:
City:
State:		Zip:
Phone:
E-mail:
I would like to receive future Clark State information by e-mail. Yes No Read Clark State's Privacy Statement
High School:
Date of Birth:	(MM/DD/YYYY)
Actual/Anticipated High School Graduation Year:
Expected Quarter of Entry:
Have You Applied or Attended Clark State Before? Yes No
Are You a U.S. Citizen? Yes No

Yes, I would like you to send me the following:

Financial aid information
Class schedule (View online class schedule)

Academic Programs:
Please select one or more academic programs of interest.

	Accounting
	Agricultural Business
	Agricultural Engineering
	Associate of Arts Transfer
	Associate of Science Transfer
	Basic Police Officer Academy
	Broadcast Captioning/CART
	Computer-Aided Design (CAD) Technology
	Computer Networking
	Computer Networking - Advanced
	Computer Network - CyberSecurity
	Computer Software Development
	Corrections
	Criminal Justice
	CyberSecurity Management
	Early Childhood Education
	Early Childhood Education Administration
	Early Elementary Paraprofessional
	Emergency Medical Services
	Engineering Transfer
	Golf Course Operations
	Graphic Design
	Human Resource Management
	Industrial Technology
	Judicial Reporting
	Landscape Design
	Paralegal (1st Year)
	Logistics and Supply Chain Management
	Management
	Manufacturing Engineering Technology
	Marketing and E-Business
	Mechanical Engineering Technology
	Medical Laboratory
	Medical Office Administration
	Nursery Operations (Horticulture Industries)
	Nursing Transition LPN to RN
	Parks and Recreation Operations
	Professional Office Administration
	Personal Interest
	Physical Therapist Assistant
	Registered Nursing/Day
	Registered Nursing/Evening
	Social Services
	Technical Systems Support
	Theatre Arts
	Turf and Landscape Operations

Certificate Programs
	Accounting
	Computer-Aided Design (CAD)
	Electrical Maintenance
	Electronics
	Management
	Manufacturing
	Multi-Skilled Health Care
	Office Administration
	Photography
	Practical Nursing

Short-Term Programs
	Computer Software Development
	EMT-Basic
	Networking
	Paramedic
	Real Estate
	State Tested Nurse Aide (STNA)

Additional Requests or Comments: