Request Information - Lakeland Community College

FUTURE STUDENTS

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FUTURE STUDENTS REQUEST FORM

Enter your mailing information below to receive a student packet.

REQUIRED INFORMATION*

First Name: *

Last Name: *

Address:*

City: *

State:*

Zip: *

Email: *

Phone: *

Have you ever taken a class at Lakeland?

Yes
No

Birth Date:(mm/dd/yyyy)*

OPTIONAL INFORMATION*

How did you hear about Lakeland?
(check all that apply)

Newspaper Advertisement
Radio Advertisement
Television Advertisement
Friend / Family
High School
College Fair
Mailing
Web Site
Other:

High School Attended:

High School Graduation Year:

Current Occupation

Current Employer

Anticipated Semester of Enrollment:

AREAS OF INTEREST

Lakeland may email me with information from the Area(s) of Interest I've selected above.
Lakeland may email me with general information.


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