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Evening Student Information Request  
Please fill in the information requested below and select submit.  
The fields in bold are required.  
First Name
Middle Initial
Last Name
Street Address
City
State or Province
State or Province (if Other)
Zip Code
Country
Home Phone Number
Daytime Phone Number
Cell Phone Number (if available)
Email
Program of Interest
Term of Entry
Year
Prior colleges or universities you have attended and the number of hours earned  
Institution 1
hrs
Institution 2
hrs
Institution 3
hrs
Institution 4
hrs
Do you have an Associate of Arts (A.A.) degree
  Yes
  No
What brought you to our Website?
If Other
Any questions you have about Rockhurst, a specific program, or the admission process