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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 .... *


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


I am interested in attending for the... *



Publications I am Interested in:


 Free Admissions Application

 Free Nursing Application

 Athletics Brochure

 Campus Viewbook: Campus at a Glance

 Clinton, Essex & Franklin County Scholarship Brochure

 Clinton's Fast Facts Sheet: Academic Programs, Campus visit dates, Cost, How to apply?

 Residence Hall Brochure

 Clinton Child Care Brochure: Care for children 18 Mo. - 5 years old


Your Contact Information:


First Name *


Last Name *


PO Box or Street Address *


Apartment


City *


State *


Zip Code *


Country *


Telephone Number (XXX-XXX-XXXX) *


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


High School Name & Graduation Year *



Academic Programs:


Transfer Degree Programs:


Career Degree Programs (Non Transfer)


Certificate Progams


 Undeclared/Undecided