Fall 2019 Health Professions and Human Services Open House Tuesday, September 24, 2019 at 5 - 7 PM
Thank you for your interest in Central Piedmont Community College's Health Professions and Human Services. Please complete the form for each person interested in applying to one of our programs. (The form doesn't need to be completed by a parent accompanying a student or school counselor).
Student's First Name *
Your answer
Student's Last Name *
Your answer
Address (Street Number and Name) *
Your answer
Zip *
Your answer
Student's Email address *
Your answer
Parent's email (if student is under 18 years of age)
Your answer
Student's phone number (Best Contact# - FORMAT XXX-XXX-XXXX) *
Your answer
Name of High School
If High School not listed above, please provide name:
Your answer
What year will/did you graduate? *
Your answer
I am interested in the following program *
Required
I plan to start classes at CPCC in *
How did you hear about the Open House *
Including yourself, how many people will be attending? (Please remember to complete a form for each person interested in one of our health professions and human services programs. The form doesn't need to be completed by anyone accompanying you.) *
Your answer
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