Information Request for Prospective Students

Thank you for your interest in Daytona State College. We can make your on-line experience better if you allow us to get to know you a little first. Please complete the fields below.

Please provide the following contact information:

First Name (Required):
Last Name (Required):
Street Address (Required):
Apt. No.:
City (Required):
State/Province (Required):
Zip/Postal Code (Required):
Work Phone:
Home Phone:
E-mail:

Your Date of Birth: (Required)

What is your planned major?

For which semester do you plan to initially enroll in classes?


If you chose other above, please let us know in a few words how you heard about us: