Laramie County Community College Prospect Card

About the student

First Name
Middle Name
Last Name
Street Address
City
State
Zip
SSN (xxx-xx-xxxx)
Birthdate (mm/dd/yy)
Email Address
Home Phone [(xxx)xxx-xxxx]
Cell Phone [(xxx)xxx-xxxx]

May we text you?

Yes No

Gender

Male Female

Are you interested in living on campus?

Yes No

Please list high school attended

High School
City
State
ZIP
Graduation Year

Intended program of study:

Comments:

Nondiscrimination Statement

Laramie County Community College does not discriminate on the basis of race, creed, national origin, religion, age, disability, political affiliation, sex, sexual orientation or marital, parental or military status in admission or access to, or treatment or employment in its educational programs or activities.