Nursing Request for Information

    Fill out the form below and we will contact you to discuss your next steps and provide you with more information about the nursing program you choose.
    Student Information
    Birthdate
    Birthdate
    Mailing Address
    Mailing Address
    Preferred Contact Method
    Preferred Contact Method
    When is the best time of day to reach you?
    When is the best time of day to reach you?

    By submitting this online form, I agree that the information I have provided is accurate. I grant Trine University permission to contact me via phone, email, and/or text messaging at the phone number and email address provided above. I understand that my consent is not required to attend Trine University and that if I would like to request information without providing consent, I may request information by contacting Trine directly at 800-347-4878 or at healthprof@trine.edu.

    Additional Information