* 1. Select your highest level of education. (Select one)

* 2. What is your current military status? (Select one)

* 3. Are you currently receiving VA educational benefits?

* 4. What educational benefits do you qualify for? (Select all/any that apply)

* 5. What are your educational interests at CCC? (Please check any and all that apply)

* 6. OPTIONAL: May we contact you?