DeVry Long Island City Passport2College Application Form

Passport2College Application Form

If you are a student, parent or teacher who would like to hear more about DeVry New York's 2009 Passport 2 College Program, please complete the following by erasing the samples and substituting appropriate information. At the end of the form, press Submit to send the information to our Community Affairs office.

First Name:	Last Name:

Street Address:

City:	State:

Zip Code:

Phone Number:	Email Address:

High School Name:

Expected Graduation Date (i.e. mm/dd/yyyy):

Recommending Teacher's Name:	Recommending Teacher's Title:

Student is primarily interested in: (check one)	Location you are primarily interested in: (check one)
Technology Business	Long Island City Manhattan
Thank you for completing the form!

If you have any questions about your application, please contact the Community Affairs Office 718.269.4351 or LIC-Passport2College@devry.edu