Student Interest Form

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Name *

example: John Smith

High School *

What year did you or will you graduate?

E-mail Address *

Phone Number *

( _ _ _ ) _ _ _ - _ _ _ _

Birthdate *

Example: 5/2/1994

What is your goal at Pasadena City College? *

2 year degree - Associate of Arts (A.A.), Associate of Science (A.S.)

Transfer to university after attending PCC

Complete a Career and Technical Education Certificate Program

Other:

Have you ever completed a PCC course?

Yes

Clear selection

Have you ever completed an ROP (Regional Occupational Program) or CTE (Career Technical Education) course?

(at your high school, a community college, or other)

Yes

Clear selection

Did either you or your parents graduate from college?

Yes

Clear selection

Do you qualify for the free/reduced lunch program at your high school?

Yes

Clear selection

Submit

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