Continuing Education Request Info Questionnaire

Personal Information

First Name:
Last Name:
Address:
City:
State:
Zip:
E-mail:
Phone:

How did you hear about Grand Valley? Check all that apply.
Newspaper
Magazine Ad
GVSU Website
Radio
E-mail
Mail Piece
Colleague or Friend
Bus Board
Other

Please indicate what information you would like to receive:
General GVSU Info
Specific Program Info
Which specific program(s) would you like information for?

Would you like somebody to call you to set up an appointment?
Yes
No

What is the first semester that you are considering enrolling for?
Fall
Winter
Spring/Summer

What campus are you interested in?
Holland Meijer Campus
Muskegon Campus
Traverse City Center
Allendale Campus
Pew Campus

Grand Valley State University is an Equal Opportunity/Affirmative Action Institution