Pikeville College - Admissions - Information Request

Pikeville College - Admission information request form.

 
 

Information Request

Please complete all items as accurately as possible. Click “Submit” at the bottom to send the request. Click “Clear” to clear the form and start over.

After the submitted form information has been processed, an “Admissions Information Packet” will be mailed to the address you provided.

This is not an online application.
First name:

Middle name:

Last name:

Gender:


E-mail address:

Mailing address:

City:

County:

State:

ZIP:

Home phone number:

Cell phone number:

Semester of interest:





Year:





High school attended:

High School graduation year:

Have you attended Pikeville College?


If yes, what year(s)?

Classification:



Please select your likely major or field of study.
Select at least one. Multiple selections can be made by holding down the “Control” key while making selections.

Please list any student activities or sports you are currently involved in or would be interested in being involved in at Pikeville College.

To help fight spam, Pikeville College is utilizing technology to differentiate between human and robotic visitors to our Web site. To ensure that this form is submitted by a human, you will be required to complete a simple test. For help, click the “question mark” icon below.