Information Request Form

  * = Required Fields

Completing this form will place you on our prospective student mailing list. All information will be maintained in a confidential manner and used solely by the college. Please complete all items on this form completely and accurately.

Contact Information:
First Name: *   Middle:   Last: *
Address: *
City: *
State: *    Zip Code: *
Age Range: *
Phone: - - *
Tell us about your Academic Interests/Goals:
I Plan to Enroll: *
I plan to attend:

  Full-time Student (12 or more semester hours)
Part-time Student (less than 12 semester hours)

My areas of interest are/planned major is:

Earning my GED:
Transfer Degree:
Career Program:
My current school or the most recent school I have attended:
School Name:
Credit Schedule
Noncredit Schedule
College Catalog
New Student Information Form
Financial Aid/Scholarship Information
I am interested in a campus tour