Clay Target Interest Form

Personal Info

First Name*

Last Name*

Preferred Name

Gender*

Birthdate*

Address*

Country

Street

City

Region

Postal Code

Phone (Home)

Phone (Mobile)

I give permission to Illinois College to send me important updates
via text messaging. (Standard message charges apply.)

Yes

Email Address*

Academic Information

I will enter college as a*

Start Term*

High School Name*

High School Graduation Year*

College Name*
(required only if a transfer student)