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ReUp Transfer Interest Form

First Name

Middle Name

Last Name

Preferred/Chosen First Name

Email Address

Home Phone

Mobile Phone

Birthdate

Birthdate

Mailing Address

Mailing Address

Country

Street

City

Region

Postal Code

When would you like to begin taking classes at Shawnee State?

Choose how you would like to take classes.

Choose how you would like to take classes.

Online

In-Person