Accelerated Learning Application

KCC Dual Credit App

About You

This application will take approximately 10 minutes to complete. You will need your email address and your phone number.

Names & Demographics

First Name

Middle Name

Last Name

Previous Last Name

Preferred name

Gender

Marital Status

Birthdate

Ethnicity & Race

To comply with federal statistical reporting requirements, Klamath Community College must seek to identify the racial and ethnic background of applicants. You are encouraged to to supply this information, but your application will be given the same consideration whether or not you do so.

Ethnicity

Race (Choose one or more)

Contact Information

Address

Country

Street

City

State or Territory

State/Territory

Zip/Postal Code

County

Are you a legal resident of OR, CA, WA, ID, or NV?

For Military personnel, base this on your home of record

Phone & Email

Mobile Phone Number

10 digits. NO Country code, spaces, or special characters.

Secondary Phone Number

Personal Email Address

example: johndoe@gmail.com, or johndoe@yahoo.com

Confirm Email Address

Email
Confirmation OK

Email
Confirmation Error

Course Information

When do you plan to start?

High School Name

Have you ever had an IEP or 504 Plan?

Hidden fields

HS Course Title

KCC Course Title

KCC Instructor Name

KCC Course Code

Academic Start Term Id

High School Id

HS Program Id

Having trouble with this form? Send us an email at admissions@klamathcc.edu

White	Native Hawaiian or Other Pacific Islander
Black or African American	Asian
American Indian or Alaska Native