Information Request Form

Please enter the requested information and click the Submit button when finished.

- indicates a required field.

Select the term for which you plan to attend LCC.

Desired Semester of Attendance
Term of Entry:

Enter your first and last name below. Please use correct spelling and proper capitalization.

Name
Prefix:
First Name:
Middle Name:
Last Name:
Suffix:
Nickname:

Enter your complete and current home address and primary phone number. Please use correct spelling and proper capitalization.
You do not need to enter Valid From: or Until: dates.

Current Home Address
Valid From:	Month Day Year (YYYY)
Until:	Month Day Year (YYYY)
Address Line 1:
Address Line 2:
Address Line 3:
City:
State or Province:
ZIP or Postal Code:
County:
Nation:
Phone Number:	- (xxxxxx)-(xxxxxxxxxxxx) (xxxxxxxxxx extension)
International Access Code:

Enter your date of birth.

Date of Birth
Date of Birth:	Month Day Year (YYYY)

Please tell us how you learned about LCC. Hold down Ctrl and Click to select more than one.

How did you learn about LCC?
How I Learned About LCC:LCC

Select the Materials you would like to receive. Hold down Ctrl and Click to select more than one.

To view a Course catalog online please go to www.lcc.edu/academics.

To view the Summer and Fall Schedule book please go to www.lcc.edu/schedule.

Request Materials
Request Materials:

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LCC

Information Request Form

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