Centralia Community College Fair

First Name

Student Preferred First Name (If different)

Middle Name

Last Name

Birthdate

Email Address

Mobile Phone Number

May we text you about events and future admission related information?

Yes

No

Mailing Address

Country

Street

City

Region

Postal Code

Academic Profile

I will enter UW Tacoma as a

Anticipated Entry Term

First Choice Major

Second Choice Major

Most Recent School Attended

CEEB Code (Hidden Field)

Are you part of the Running Start program?

Yes

No