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Request Information

by Webmaster — last modified August 06, 2009 08:25 AM

Fill out this form to request more information from Faulkner State!

Complete this form and click the "submit" button to request information from Faulkner State.  Fields with a red dot are required.

(Required)
Please type out your first and last name.
(Required)
Enter the address where you receive your mail
Enter the second line of your address (if necessary)
(Required)
Enter the city where you receive your mail
(Required)
Enter the two-letter state abbreviation
(Required)
Enter the zip code where you receive your mail
(Required)
Enter a valid email address where you can be reached
Enter a telephone number where you can be reached
Enter your cell phone number
(Required)
/ /
Enter the name of the high school you are attending
(Required)
Please list all the programs of study you are interested in pursuing at Faulkner State
characters remaining
(Required)
Select the term you would like to begin



(Required)
Enter the year you would like to enroll
(Required)
Place a checkmark next to each item that you are interested in
Mark as many boxes as necessary to let us know how you heard about us
Please enter anything else you would like for us to know

Please be sure your mailing address and email address are both correct!  Thank you!


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