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	Domestic (U.S.) Student Information International Student Information
Personal Information:
First Name:	*
Middle Initial:
Last Name:	*
Street Address:	*
City:	*
State or Province:	*
Zip or Postal Code:	*
Country:
This is my	Select One Home School Temporary address.
Telephone:	(include area code or country code if international)
This is my	Select One Home School Temporary telephone number.
Email Address:
Academic Information
The name of your high school:
Year of high school graduation:
Anticipated Study at Clark
You are considering entering as a Clark student in what semester and year?	Fall Spring of
Field of study, or intended academic major
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