Interest Form

Interested in Clark State? Let us know!

We're excited to welcome you to Clark State! Please fill out the form below to join our mailing list and learn more about what Clark State can offer you.

Personal Information

First and Last Name: *

Date of Birth : *
Example: DD/MM/YYYY

Street Address: *

City: *

State: *

Zip Code: *

E-mail: *

Phone Number:

What high school did you attend? *

What year did you/will you graduate from high school? *

If you have attended any college, please enter the name of the college below.

Intended Major: *

What semester do you hope to start? *

I’m interested in attending classes in: *
Please check all that apply.

Beavercreek

Bellefontaine

Springfield

Xenia

Online

Have you completed the Clark State application yet? *

Questions? We're here to help!

Admissions - Springfield Sara T. Landess Technology and Learning Center

937.328.6028 admissions@clarkstate.edu

Admissions - Beavercreek Greene Center

937.429.8819 greenecenter@clarkstate.edu

Admissions - Bellefontaine Ohio Hi-Point

937.599.7602 bellefontaine@clarkstate.edu

Admissions - Xenia Xenia YMCA

937.431.7171 xenia@clarkstate.edu