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Prospective Student Information Request

如果你有兴趣参加CLC，并想了解更多信息，请填写以下表格。

Please provide your contact information.

First Name

Last Name

Street Address

City

State

Zip/Postal Code

Email Address

Verify Email Address

Mobile Phone Number

Home Phone Number

你首选的联络方式是什么?

EmailPhone

Please tell us about yourself.

I am a/an...

High School StudentAdult Student

High School

Choose "Unknown School" if no match.

Graduation Year

Are you a Lake County Technology Campus Student?

Yes

No

What is your interest in CLC?

Academic Program

When do you plan to attend?

Are you interested in Guaranteed Transfer Admission Partnership?

Yes

No

Please select the transfer institutions you are interested in. You may select multiple options.

Press and hold "Ctrl" on your keyboard to select multiple options.

Parent/Guardian Contact Information (Optional)

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address

Would the parent/guardian prefer to receive information from CLC in Spanish?

YesNo

Contact Information