Request edit access
DESTINO STEM Interest Form
Thank you for your interest in the DESTINO STEM program at Long Beach City College. Please allow 5-10 minutes to complete the entire interest form.  Our program staff will contact you as soon as your interest form has been reviewed. If you have any questions, send me an email at rolmos@lbcc.edu
Sign in to Google to save your progress. Learn more
Name
LBCC Viking ID
Address
Email
Phone Number
Date of Birth
MM
/
DD
/
YYYY
What is your ethnic/racial background?
Are you a Veteran of the U.S. Armed Forces?
Clear selection
Name of Last High School Attended?
Month and Year of High School Graduation or Completion
If you attended a college prior to LBCC please list college below (if LBCC is the only school write N/A):
How many units are enrolled for the Fall of 2024?
What is your major?
How many hours do you work per week?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms