Coker College : Admissions and Financial Aid

Evening Program Information Request

Take a moment to tell us about yourself. We are glad that you are interested in Coker College at Night and
would like to get to know you better. Please fill out this brief form. Thank you!

PLEASE NOTE: You must be at least 23 years old and out of high school for at least five years to be eligible for Coker College's Evening & Extended Studies Program.

Name
Street Address
City
State		Zip Code
Telephone	( ) -
E-mail Address
Date of Birth (MDY)	/ /
Intended Major
High School
Graduation Year
Will you enter Coker as Freshman or as a Transfer?	Freshman	If a Transfer, from what college?
Will you enter Coker as Freshman or as a Transfer?	Transfer
Semester you'd like to start at Coker
Would you like to be sent any of the following publications?	Financial Aid Information	Academic Information

Check if you would like to be contacted by an Admissions Counselor.

Office of Admissions | 300 E. College Ave. | Hartsville, SC 29550 | Phone: 1-800-950-1908
Fax: 843-383-8056 | admissions@coker.edu