Last Name *

First Name *

Middle Intiial

Address *

City *

State *

Zip *

E-mail *

Phone (###-###-####) *

This phone number is a Cell phone Land line Other *

Are you currently in high school? Yes No *

Which program/major is of most interest to you? Select... Undecided Accounting Accounting & Information Technology Art Arts Science Transfer Classes Agriculture Automotive Repair Business Administration Business General Business Systems Networking Carpentry Child Development Collision Repair Computer Science Drafting Education Electrical Technology Graphic Design Management Info Systems Math Medical Transcription Music- Instrumental Music - Vocal Nursing Office Systems Physical Education Physical Science Psychology Science Related Web Design and Development Welding Other *

If other, please specify:

What year are you interested in starting at SWCC? Select... Undecided Spring 2012 Fall 2012 Spring 2012 Fall 2013 Spring 2013 Fall 2014 Spring 2015 Fall 2015 Spring 2016 Fall 2016 Spring 2017 Spring 2018 Fall 2018 *

Actvities interests (check all that apply) Band
Baseball
Basketball
Choir
Cross Country
Golf
Softball
Volleyball

What influenced you to schedule your campus visit? High school counselor
Direct mailing/postcard
Radio ad
Signs
TV ads
Friends or family
Newspaper ad
School visit/college fair
Web site