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GradSchools.com Advertising Information Request Form
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*  Your Name:
Title:
*  Institution Name:
Department:
Address:
City:
State/Province:
Zip/Postal Code:
Country:
*  Email:
*  Phone:
Fax:
What type of Programs do you offer?
       On campus within the United States   (Number of students enrolled annually)  
       On Campus outside the United States   (Number of students enrolled annually)  
       Distance/Online Education Programs   (Number of students enrolled annually)  

Current School/Department Web site:  
How do you rate your site?     Needs Help       Fair       Good       Excellent       Don't Know

Do you currently advertise on the Web?     Yes   No
If yes, how are your results?     Poor       Fair       Good       Excellent       Don't Know
How do you measure these results?  

Please check all of the services you plan to implement:
Standard Listings Master Sponsorship Banner Ads Hot Buttons Midway Ads
Student Search Lists Email/Postal Marketing Other(specify):

Please select the approximate budget amount you are interested in:
$500 $5,000 $50,000 $500,000

I want to implement a program:
Within 1 week       Within 1 month       Within 3 months       Within 6 months