Behavioral Health & Human Services Academic Showcase

Thursday, November 21, 2024 at 6:00 PM until 7:00 PMEastern Standard Time UTC -05:00

Join us for the Behavioral Health and Human Services Academic Showcase! This event is VIRTUAL.

Please complete the below form and you will get a confirmation email upon submission. If you have any questions please email us at admissionevent@ccp.edu.

Personal Information

First Name*

Middle Name

Last Name*

J number (if known)

Date of Birth*

Legal Sex*

Permanent Address (all fields are required)*

Country

Street

City

Region

Postal Code

Contact

Email Address*

Preferred Phone*

Home Phone*

Cell Phone*

May we text you? *

Yes

High School/Academic Interests

Most Recent High School Attended*

Did/will you be graduating from high school or earning a GED? *

Yes

Year of Graduation*

Expected Entry Term*

Intended Area of Interest 1*

Intended Program of Interest 1*

Intended Area of Interest 2

Intended Program of Interest 2