Request for Information

Thank you for your interest in Coastal Carolina University. To receive more information regarding academic majors, the application and admissions process, or to contact an admissions counselor, please complete this form.

We look forward to hearing from you!

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Contact Information

* First Name

Middle Name

* Last Name

* Email Address

* Birthdate

Gender

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Pronouns

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She/Her

They/Them

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* Mailing Address Information

Country

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Region

Postal Code

Student's Mobile Phone Number

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Academic Information

* What type of admission are you interested in knowing more about?

* When are you thinking of enrolling?

* Major of Interest

* Have you attended any other colleges since leaving Coastal Carolina University?

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Please choose a program or area of interest:

If you would like, please choose an area of interest/specialization for this major:

High School Information

Current High School Name

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College Information

Most Recently Attended College Name

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Other College Attended (if applicable)