U.S. students:
To submit your enrollment fee on-line, please complete the form below. The enrollment fee is $25. Items in bold must be filled in before you can submit the form.

Items in bold must be filled in before you can submit the form.

Student's Name
Student's Social Security Number
Home Phone
E-Mail
Payment For:
Amount (US currency)
Name on credit card
Card Holder Billing Address
Card Holder Billing City
Card Holder Billing State
Card Holder Billing Zip Code
Choose Credit Card Type
Credit Card Number(Number Only - No Dashes)
Credit Card Expiration Date(mm/yy Format)

Note: The information submitted on this form is protected by a secure server and is encrypted between the server and the Office of Admission. Follow the privacy link to learn about our privacy policy.

If you have questions, please call the Office of Admission at (480) 209-3549 or (800) 347-4878 or e-mail peoria@trine.edu