Request for Information

We appreciate your interest in Trine University's Surgical Technology Program. Please use the form below to request information about this program.

* Denotes Required Fields

Student Information

First Name *

Middle Name

Last Name *

Birthdate *

Email Address *

Address Information (Required)

Country

Street

City

Region

Postal Code

Cell Phone Number *

Enrollment Information

Type of Student:
Select First Year if you are still in high school and/or completed high school, but never attended college.
Select Transfer if you have ever enrolled in ANY college degree program after high school graduation. (For Trine University degree seeking students you would be considered a Transfer Student for the Surgical Technology Program.)

Type of Student *

First Year Student

Transfer Student

Current Trine University Student:

Yes

No

Intended Academic Entry *

Education Information

Search for your High School *

CEEB Code *

High School Graduation Date *

High School Cumulative GPA *

ACT/SAT Composite

Your Most Recent College

College Cumulative GPA