Santa Clara University

CPED

Request Information

We appreciate your interest in the School of Education and Counseling Psychology and want to learn more about you to serve you better. Please answer the questions on this page to allow us to customize our communications with you.

All questions marked with an asterisk(*) are required. Santa Clara University respects your privacy. Your information will not be shared with third parties.

Contact Information

First Name *
Middle Name
Last Name *
Address (1) *
Address (2)
City *
State/Province *
(USA/Canada only)
Postal Code *
(USA/Canada only)
Country *
Phone
Email *
Program preference *
I'm intending to enroll...*
How did you hear about the School of Education and Counseling Psychology *
Are there any specific questions that you have for us?

Optional Additional information

Birth Date
Gender
Demographics
  1. Are you Hispanic/Latino?

    Yes, Hispanic or Latino (including Spain)
    No

  2. Regardless of your answer to the prior question, please indicate how you identify yourself. (Check one or more.)

    American Indian or Alaska Native (including all Original Peoples of the Americas)
    Asian (including Indian subcontinent and Philippines)
    Black or African American (including Africa and Caribbean)
    Native Hawaiian or Other Pacific Islander (Original Peoples)
    White (including Middle Eastern)