Request for Information

Please fill out the form below to be added to our mailing list and receive information about Henderson State and upcoming events.

Note: All fields marked with an asterisk (*) are required.

First Name *

Last Name *

Birthdate*:

Mailing Address

Country

Street

City

Region

Postal Code

Student Cell Phone

Would you like to receive text updates from Henderson?

Email Address *

What year did you or will you graduate from high school?*

I will enter Henderson State as a *

Freshman - Student who has not attended college after graduating from high school (excluding summer classes).
Graduate - Student with a bachelor's degree applying to graduate school.
Transfer - Student who has attended a fall or spring college term after graduating from high school.

Major of Interest *

What career path(s) are you interested in? (Select up to two)

Career Path 1: *

Career Path 2 (optional):

High School *

College/University Most Recently Attended *

CEEB Code

When will you enroll at Henderson State?*