EvCC Information Request Form
First Name: *
Your answer
Last Name: *
Your answer
Address
required if you would like EvCC to include you in mailings
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Email *
will be used as primary mode of communication
Your answer
Email: *
confirmation
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Phone
best number to reach you
Your answer
Last high school or college attended? *
if you earned college credit while in high school only list your high school
Your answer
High school or college/university state *
Your answer
Have you graduated from high school? *
Year of graduation *
or anticipated graduation
Your answer
When would you like to start at EvCC? *
I am a... *
check all that apply
Required
What are your academic goals? *
What area of study are you interested in? *
program or major
Your answer
What activities would you like to learn more about at EvCC?
check all that apply
Would you like more information regarding EvCC's Student Services?
please check all that apply
I am the first in my family to go to college *
Is there anything else you would like to share or need information about?
Your answer
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