University of Southern Indiana - Graduate Studies: Request Information

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Graduate Studies
Wright Administration Building
Room WA 104
University of Southern Indiana
8600 University Boulevard
Evansville, IN 47712
Phone: 812-465-7015
Fax: 812-464-1956
E-Mail: gssr@usi.edu

Request Information
First Name
Last Name
E-mail address
Telephone
Birth date (mm/dd/yyyy)	/ /
Entry Term

Additional information about yourself
Do you have a bachelor's degree?	Yes No
College/University Attended:
College/University City
College/University State
College/University Country
Year graduated or will graduate
Have you applied for graduate admission to USI?	Yes No
Area of academic interest
Other area of academic interest (if not listed):
USA Addresses:
Address (line 1) Address (line 2)
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County of origin
International Addresses:
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Additional comments:

8600 University Boulevard - Evansville, IN 47712-3596 - 812/464-8600

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