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College Connections Experience
Interest Form
Fields with an asterisk (
*
) are mandatory.
Personal Information
Full Name
*
First Name
*
Middle/Maiden
Last Name
*
Date of Birth
*
Gender
select type
Female
Male
Non-Binary
Prefer Not to Answer
Email Address
*
Phone Number
*
Number
Phone Type
select type
Home
Cell
Business
Other
Address
*
Mailing Address
City
State
Zip
T-Shirt Size
select type
XS
S
M
L
XL
XXL
3XL
Education History
Your High School
*
select
Home School
Local High School
Adult High School
Other
Your Current Grade Level
*
select
11th
12th
Adult High School
Graduated
Other
Potential Career Interests (Check all that apply)
University transfer
Health Sciences
Industrial Technologies
Information Technology
Public Safety
Transportation Technologies
Business Technologies
Engineering or Manufacturing Technologies
Cosmetic Arts
Not Sure
Other
If "Other" Potential Career Interests, Please Include
Will you be available from June 14 - August 3, Tuesday and Thursday from 9am to 2pm?
select
Yes
No
Not Sure
If not available during the designated time, when are you available?
Will you need transportation?
select
I have transportation
I will need transportation from the Harnett Main Campus (Lillington)
I will need transportation from the Chatham Main Campus (Pittsboro)
I will need transportation from within Lee County
Not Sure
Current High School GPA (if known)
Have you attended any college classes before?
select
Yes
No
Have either of your parents attended college classes before?
select
Yes
No
Not Sure
Interest
Please explain (1-3 sentences) why you would like to be a part of this program
Submit