Keep me Informed Interest Form 2021-22

Keep Me Informed!

Cal Poly Pomona offers a unique education where creativity, discovery and innovation come to life.

Name*

First Name

Last Name

Preferred Email*

Phone

Keep me informed, I'm a:*

High School or K-8 Student Community College Student Parent/Family Member Educator

Current High School or K-8 School*

Please enter full school name.

What is your Statewide Student Identifier (SSID) number?

This is a unique 10-digit number, which may be found in your student ID and transcript.

When will you graduate from high school?*

Class of 2022 Class of 2023 Class of 2024 Class of 2025 Class of 2026 Class of 2027 Class of 2028-2033

Current Community College Attending*

Please enter full community college name.

Are you completing an Associate Degrees for Transfer (ADT)*

Yes No Not sure

What is your major?*

Please enter full major (no abbreviations).

Year Interested in Applying*

What year will you apply to enter Cal Poly Pomona?

My student is in:*

Community College High School Middle School Elementary

Student Name*

First Name

Last Name

Student Email

Full Name of HS, CCC, or Community Institution*

Title or Position*

Home Address*

Address Line 1

City

State

ZIP Code

I agree to receive information from Cal Poly Pomona's Office of Student Success. *

Yes