Contact Us - Request Information

Request Information

Fill out and submit the form below to receive more information on our undergraduate programs. Learn more about Eureka College!

First Name*

Last Name*

Date of Birth*

Gender*

Address*

Address 2

City*

State*

Zip Code*

Country*

Email Address*

Parent Email

Primary Phone*

Other Phone

Would anyone in your household like to receive information about Eureka College in Spanish?

Yes

Enrollment Term*

Fall Term

Spring Term

Student Type*

High School Name

Graduation Date

GPA on a 4.0 Scale

ACT Score

SAT - Verbal

SAT - Math

SAT - Writing

Colleges Attended

Intended Major

Intended Minor

Athletics

How did you Hear About Eureka College?

Extracurricular (general interests)

Have a Specific Question?

About Yourself

High School

Your Interests