Interest Form

To recieve more information regarding the Collegiate Connection program or to request admission into a course, please fill out the following form. Please note that this is not an application form.

Personal Information

Name:
Email:
Address:
City:
State:
Zip Code:
Primary Phone:
Secondary Phone:
High School:
I believe I am eligible for Financial Aid

Course Information

Please indicate the IPFW course you are interested in taking. Note: You will only be registered in your second choice if your first choice is full.

First Choice

Course Title:
Course Number:
Day(s):
From:	a.m. p.m.
To:	a.m. p.m.

Second Choice

Course Title:
Course Number:
Day(s):
From:	a.m. p.m.
To:	a.m. p.m.

Additional Course(s)

If you would like to enroll in two classes, please indicate the additional course below. Note: You will only be registered in your second choice if your first choice is full.