Intake Form (For Inquiries)

Please Note: If you need to update student application information, please use the Application Update Form (this will link to the form once it's been created).

Bio/Demo/Contact

First Name *

Preferred Name

Middle Name

Last Name *

Email Address

Phone Number

Mobile Number

Text Opt In Flag

Yes

No

Birthdate

Gender

Female

Male

International Student

Yes

No

International Student (Manual Lock)

Yes

No

City of Birth

Mailing Address

Country

Street

City

Region

Postal Code

Academic Interest(s)

Entry Term

First Choice Major

Second Choice Major

Combined Degree Flag

Yes

No

Combined Degree - Anticipated Undergrad Graduation Term

Combined Degree Ineligible Flag

Yes

No

Combined Degree Academic Interest (current DePaul undergraduate students only)

Primary Instrument

KGSB Concentration

RN MS Level

RN MS Career Interest

Nursing Cohort

SPS Location

CDM Online Program Interest

Yes

No

Other

Stop Communication

DePaul Alumni

Yes

No

Military Flag

Yes

No

Fulbright Eligible

Yes

No

PeaceCorps Eligible

Yes

No

International Agency

Employment

Employer

Is this employer part of the EdAssist Network?

Yes

No

CEO Cohort Interest

Yes

No

CEO Recruiter ID

CEO Company Inquiry

Previous Cohort Inquiry

City of Chicago Department

CDM Micro-Credential Interest

COE Cohort Inquiry

COE AUSL (Admitted) Resident Flag

KGSB DBA High Potential Flag

KGSB Exec. MSHR High Potential Flag

KGSB MBA Hospitality Interest Flag

KGSB MBA Mt. St. Vincent Interest Flag

KGSB MSA Online Interest Flag

Interaction Information

Interaction User

Interaction Code

Interaction Subject

Interaction Comments

Intake Form (For Inquiries)

DePaul University