Request for Information

Student Information

First Name*

Preferred Name

Last Name*

Birthdate*

Email Address*

Mailing Address

Country

Street

City

Region

Postal Code

Student Type*

First-Year Student

Transfer

Note: Students who are in high school taking CCP courses would be considered First-Year Student.

Parent Information - Optional

Relationship Type

Parent First Name

Parent Last Name

Parent Email

Academic Information

Anticipated Start Term*

Academic Area of Interest

Current High School*

High School Graduation Year*

Most Recent Transfer Institution