Contact The University of Illinois Global Campus

Complete this form to inquire about a University of Illinois online program, or call us at 1-866-896-3939. Your information will be kept confidential and will be used only in our direct communications with you. Privacy Statement

	* indicates required field
First Name *
Last Name *
Primary Phone *	Include at least 10 digits. International numbers should include country code.
Alternate Phone
E-mail *	e.g., example@example.com
Address1
Address2
City
State (U.S. only)	-- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
State / Province (non-U.S.)
Zip / Postal Code *
Country	-- United States -- U.A.E. Afghanistan Antigua and Barbuda Anguilla Albania Armenia Netherland Antilles Angola Antartica Argentina American Samoa Austria Australia Aruba Azerbaijan Barbados Bangladesh Belgium Burkina Faso Bulgaria Bahrain Burundi Benin Bermuda Brunei Darussalam Bolivia Brazil Bahamas Bhutan Bouvet Island Botswana Belarus Belize Canada Cocos (Keeling) Islands Central African Republic Congo Switzerland Cote D'Ivoire Cook Islands Chile Cameroon China Colombia Costa Rica Cape Verde Christmas Island Cyprus Czech Republic Germany Djibouti Denmark Dominica Dominican Republic Algeria Ecuador Estonia Egypt Western Sahara Spain Ethiopia Finland Fiji Falkland Islands (Malvinas) Micronesia, Fed. States of Faeroe Islands France Gabon United Kingdom Grenada Georgia French Guiana Guernsey, C.I. Ghana Gibraltar Greenland Gambia Guinea Guadeloupe Equatorial Guinea Greece Guatemala Guam Guinea-Bissau Guyana Hong Kong Heard and McDonald Islands Honduras Haiti Hungary Indonesia Ireland Israel Isle of Man India British Indian Ocean Territory Iceland Italy Jersey, C.I. Jamaica Jordan Japan Kenya Kyrgyzstan Cambodia Kiribati Comoros Saint Kitts and Nevis Korea, Republic of Kuwait Cayman Islands Kazakhstan Lao Peoples Democratic Repub. Lebanon Saint Lucia Liechtenstein Sri Lanka Liberia Lesotho Lithuania Luxemborg Latvia Morocco Monaco Moldova, Republic of Madagascar Marshall Islands Mali Myanmar Mongolia Macau Northern Mariana Islands Martinique Mauritania Montserrat Malta Mauritius Maldives Malawi Mexico Malaysia Mozambique Namibia New Caledonia Niger Norfolk Island Nigeria Nicaragua Netherlands Norway Nepal Nauru Niue New Zealand Oman Panama Peru French Polynesia Papua New Guinea Philippines Pakistan Poland St. Pierre and Miquelon Pitcairn Puerto Rico Portugal Palau Paraguay Panama Canal Zone Qatar Reunion Romania Russian Federation Rwanda Saudi Arabia Solomon Islands Seychelles Sudan Sweden Singapore St. Helena Slovenia Svalbard and Jan Mayen Islands Slovakia Sierra Leone San Marino Senegal Somalia Suriname Sao Tome and Principe El Salvador Swaziland Turks and Caicos Islands Chad French Southern Territories Togo Thailand Tajikistan Tokelau Turkmenistan Tunisia Tonga East Timor Turkey Trinidad and Tobago Tuvalu Taiwan Tanzania, United Republic of Ukraine Uganda U.S. Minor Outlying Islands Uruguay Uzbekistan Vatican City State St. Vincent and the Grenadines Venezuela Virgin Islands (British) Virgin Islands, U.S. Viet Nam Vanuatu Wallis and Futuna Islands Samoa Yemen, Republic of South Africa Zambia Zaire Zimbabwe Iran Libya
How did you hear about us?	-- Brochure or direct mail Community college E-mail Employer or co-worker Family member or friend Internet banner ad Internet educational directory site Internet search engine (Google, etc.) Print ad (newspaper, magazine, etc.) Radio or TV Telemarketer Train or bus ad U of I web site or publication Other

Urbana Office (and general mailing address):

University of Illinois Global Campus
510 Devonshire Dr. Suite H, MC-661
Champaign, IL 61820
United States

Chicago Office:

University of Illinois Global Campus
205 Roosevelt Road Building, MC-015
728 West Roosevelt Road
Chicago, Illinois 60607
United States