CSU, Dominguez Hills - University Outreach & Information Services

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INFORMATION REQUEST FORM

Please fill out the following form to have an application and other information sent to you.
Items marked with an * are required to process your inquiry.

*Name :
*Address 1 :
Address 2 :
*City :	State : Zip Code :
*Country :
	Sex: Male Female Social Security Number :
Date of Birth
Term:	Year:
	Phone Number :
	Date of High School Graduation :
	Intended Major :
	Freshman Transfer
Email:

Please Indicate what information you would like to receive
example: application, requirements, etc.

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California State University, Dominguez Hills - 1000 E. Victoria Street Carson, California 90747 (310) 243-3696
Copyright © 2003 CSUDH. All rights reserved.
If any of the material is in violation of a copyright, please contact copyright@csudh.edu.
The statements found on the (departments /college / auxiliary) Web page are for informational purposes only. While every effort is made to ensure that this information is up to date and accurate, official information can be found in the University Catalog and Class Schedule.
Last updated 06/03/2004 11:28 AM , by the Outreach website committee (jc)