RACC Information Request

Please complete the following information. The fields marked with a red asterisk (*) are required.

* Date: Ex. 01/01/2011
* Last Name:  
* First Name:   Mid Int:
* Address:  
* City:  
* State:   * Zip:
* Birth Date: Ex. 10/10/1990
* Phone:
* E-mail:
* High School Attended:  
* Year Graduated: Ex. 1995
* Intended Major:  
* Semester:  
Schedule Tour:
Contact Name:
Best Time:
* How did you hear about Reading Area Community College:  
Have you ever taken credit courses at RACC?