Contact

Thank you for your interest in CCCU! Please complete this form so we can keep in touch about events we’ll be hosting in your area and on campus.

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About You

First Name *

Middle Name

Last Name *

Preferred First Name

Gender

Birthdate*

Contact Information

Email Address *

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Mailing Address *

Country

Street

City

State

Postal Code

Additional Information

Most Recent School Attended *

I plan to apply as a: *

FreshmanTransfer

I plan to enter CCCU in: *

I plan to study:(select one)