Health Career Getting Started Session Registration Form

COCC Health Careers Individual Getting Started Session

Event Registration Form - Number of Guests

* First Name

* Last Name

Chosen First Name (To be used on COCC communications)

* Date of Birth

* Would you like to meet on Zoom, over the phone, or in-person at the COCC Bend Campus?

Zoom
Phone
In-Person at the COCC Bend Campus

* Address

* City

* State

* Zip

Phone Type

* Phone

* Can we send you occasional text messages regarding important dates and event reminders?

Yes
No

* Personal Email Address

* Are you currently in high school?

* What year will you graduate?

* High School CEEB Code

* High School Name

* High School State

* I plan to enroll:

Academic Interest

Are you interested in veteran/military-connected resources at COCC?