Campus Connections Inquiry Form

Basic Information

First Name*

Middle Name

Last Name*

Gender*

Email Address*

Verify Email Address*

Mailing Address*

Country

Street

City

Region

Postal Code

Phone*

Mobile Phone

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I do not wish to receive text messages

Birthdate*

Country of Citizenship*

Are you Hispanic or Latino?*

Yes

Academic Interests

My intended admission type will be *

Term you plan to enroll in Campus Connections at both Missouri S&T and East Central*

Intended Major*

High School Information

High School Name*

High School Address*

Country

Street

City

Region

Postal Code

High School Graduation Year*

GPA*

College/University Information

College/University Name*

College/University Location*

Country

Street

City

Region

Postal Code

GPA*

Campus Connections Inquiry Form

Missouri University of Science and Technology

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