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Information Request

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

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

I am interested in attending the... *

Do you plan to attend classes? *
 On Campus
 On Campus AND Online
 Online only

Your Contact Information:

First Name *

Last Name *

PO Box or Street Address *


City *

State *

Zip Code *

Telephone Number (XXX-XXX-XXXX) *

Email Address *

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

High School Name & Graduation Year *

Academic Programs:

Transfer Degree Programs:

Career Degree Programs (Non Transfer)