Full Name (required) – Please enter your first and last name

Mailing Address (required) – Enter the address where you receive your mail

Mailing Address line two

City (required)

State (required)

Zip code (required)

Telephone number

Cell phone number

Email address (required) – Enter a valid email address where you can be reached

High school name – Enter the name of the high school you are attending

Current grade

I am interested in the following programs of study (required) – Please list all the programs of study you are interested in pursuing at Faulkner State

Term (required) – Select the term you would like to begin
 Fall
 Spring
 Summer

Year (required) – Select the year you would like to begin
2011 2012 2013 2014 2015 2016

Please send me the following items (required) – Place a checkmark next to each item that you are interested in
 Application for Admission
 Schedule
 Catalog
 Financial Aid
 Residence Hall Application

How did you hear about us? Mark as many boxes as necessary to let us know how you heard about us.
 Internet Search Engine
 Newspaper
 Radio Billboard
 Word of Mouth / Friend
 Program Graduate
 Employer
 Other

Message – Please give us any additional information you would like us to know