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EvCC Information Request Form
First Name:
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Last Name:
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Address
required if you would like EvCC to include you in mailings
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City
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State
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Zip
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Email
will be used as primary mode of communication
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Email:
confirmation
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Phone
best number to reach you
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Last high school or college attended?
if you earned college credit while in high school only list your high school
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High school or college/university state
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Have you graduated from high school?
Year of graduation
or anticipated graduation
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When would you like to start at EvCC?
I am a...
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What are your academic goals?
What area of study are you interested in?
program or major
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What activities would you like to learn more about at EvCC?
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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?
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