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First Name:
Last Name:
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Address:
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Phone Number:  (required)
Email Address: (required)
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Are you currently enrolled at Shasta College?    yes    no

Are you enrolled in an online course at Shasta College?    yes    no

Have you attended other colleges/universities?    yes    no

If you answered 'yes', are your transcripts on file with the Admissions & Records office?    yes    no

What is/are the name(s) of the other school(s)? 

What name(s) did you use while you attended the other school(s)?  

What is your major?   

Educational Objective:   

Certificate
AA/AS Degree
BA/BS Degree
Other (please specify)   
 

What is your career goal?   

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