Adult Inquiry Form

The Fleer Center offers female and male students, ages 23 and up, the opportunity to continue their education on a full-time or part-time basis. Our staff is dedicated to creating lifelong relationships with our adult students and serving as sources of support throughout their college careers. To learn more about Salem, please fill out the information below.

Have you ever been enrolled at Salem College?*

Yes

Please contact the Fleer Center for Adult Education at fleercenter@salem.edu to see if you are eligible for readmittance.

First Name

Middle Name

Last Name

Preferred Name

Cell Phone Number:

Email Address

Preferred Method of Contact:

Call

Text

Birthdate

Mailing Address

Country

Street

City

Region

Postal Code

Planned Entry Year

2024

2025

Planned Entry Term

Fall

Spring

Summer

Gender

Female

Male

Academic Interest 1

What is your educational goal? (Only choose one)

2nd Bachelors Degree

Bachelor's Degree

Certificate Program (Not-for-Profit Management; Injury-Preventive Keyboard Technique and Accounting)

I just want to take a few classes, not pursuing a degree or certificate.

Have you attended Salem College before?

Yes

if so, when?

If you are a member of Phi Theta Kappa, please check the box?

Yes

Have you ever attended another college?

Yes

College Name 1:

College Name 2:

College Name 3: