1:

What is your age?

2:

What year did you graduate HIgh school or earn your GED?

3:

What is your highest level of education?

--- Select One --- GED High School Bachelors Masters Doctorate Technical Diploma

4:

When do you plan to enroll in school?

--- Select One --- Next 3 Months Next 6 Months Next Year

5:

Would you prefer campus base or online education?

campus base online education

6:

How serious are you about pursuing further education?

Very Serious Serious Considering Just Researching

7:

Are you a US citizen?

Yes No

8:

Are you affiliated with the US military?

Yes No

9:

What is your zipcode?

10:

What is your email address?

11:

First Name

12:

Last Name

13:

Street Address

14:

Phone