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Information Request

Thank you for your interest in Clinton Community College! Please indicate the type of information you'd like to receive, along with your contact information.

I am interested in attending for the.... *

I'm interested in CCC because of a .... *

If Other, please list source

First Name *

Last Name *

PO Box or Street Address *


City *

State *

Transfer Degree Programs:

Zip Code *

Country *

Telephone Number (XXX-XXX-XXXX) *

Email Address *

Date of Birth: (MM/DD/YYYY) *

High School Name & Graduation Year *

Academic Programs:

Career Degree Programs (Non Transfer)

Certificate Progams


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