Information Request

Looking for more information? Fill out the information request form and we will mail you information about our excellent academic programs, wonderful North Carolina location, financial aid and much, much more.

Also, feel free to ask questions in the space provided.

First Name
Middle
Last Name
Address
City
State
Zip
E-mail
Phone
Age

Male Female
Name of Current High School or College

Year of High School Graduation

GPA (4.0 scale)

What program are you most interested in?

What extracurricular activities are you most interested in? (Check All That Apply) Band ROTC Choir No Interest

What intercollegiate athletic interests do you have? (Check All That Apply)

	Baseball		Men's Golf
	Bowling		Softball
	Cheerleading		Tennis
	Cross Country		W Basketball
	Football		W Volleyball
	M Basketball		No Interest

My present interest in ECSU is:
Very Interested
Somewhat Interested
Uncertain

How did you hear about ECSU?

Please type in any comments or requests:

Thank you very much for inquiring about Elizabeth City State University. All information is kept confidential and will not be distributed outside ECSU.