Please complete the form below.

First Name*
Last Name*
Street Address*
City*
State*
Zip Code*
Would you like a Distance Education Representative to contact you by phone?*	Yes No
Phone Number
When would be a good time for a Distance Education Advisor to contact you for a phone appointment? VU Distance Education Advisors are available from M-F 8:00 a.m.-4:30 p.m. (VU is on Eastern Standard Time)
Email Address
Please check all areas of interest:	Accelerated Degree 8 Week Courses (accelerated) Semester Courses (16 wk.) Open Enrollment (6 months) Correspondence Courses
What major or subject are you interested in studying?*
Have you ever been a student at Vincennes University?*	Yes No
Are you currently in the Military or have been in the past? (special opportunities may pertain)	Yes No
Comments
How did you hear about VU Distance Education?
All fields marked with an asterisk (*) are mandatory.