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Inquiry Record Form

* Student's Name:

* Address:

* City:

* State:

* Zip:

Home Phone:

 Cell Phone:

* Email:

Currently enrolled at      High School

Dropped out of      High School

Please select the appropriate date and time from the list below. NOTE: all information meetings are held on Wednesdays. If Wednesdays will NOT work for you, please contact our office at 517-483-9707 to schedule an alternate time.

March 4, 2015 4-5pm

March 11, 2015 3-4pm

March 18, 2015 4-5pm

March 25, 2015 3-4pm

* You are eligible for the program if you:

are between 16 and 19 years old

reside in Ingham County or Eaton County

have finished at least 1/2 of your high school credits

* Referred by:

High School Personnel

LCC Personnel

TV Public Service Announcement

TV Interview

Radio Interview

Radio Commercial

Friend/Word of Mouth

Special Event

Mailing

NCG or Celebration Cinema

LCC Website

Community Partner Meeting

Community Partner Mail

Juvenile Justice System

Other

 

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High School Diploma Completion Initiative at Lansing Community College

High School Diploma Completion Initiative
Mackinaw Building, Room 214
Phone: (517) 483-9707
Additional contact information »

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