Admissions Information Request Form

The following items are available online:

To request additional information, complete the form below, and click Submit.
Please be sure to provide enough information for return contact.

Full Name^(req):

(First & Last Name)

Address:

City:

State:

Zip:

Phone Number:

(xxx-xxx-xxxx)

Date of Birth^(req):

(mm/dd/yyyy)

Email Address:

High School:

Year of Graduation:

Intended Major:

Are you a first generation college student? yes no

When do you want to begin at HCC?

Additional Information Requests:

Remarks

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