ENROLLMENT CENTER CONTACT INFORMATION Question Title * 1. Contact Information First Name: Middle Name: Last Name: Callback Phone Number: Email Address: Question Title * 2. Do you prefer callback? Morning (9:00 - 12:00) Afternoon (1:00 - 5:00) Evening - (6:00 - 8:00) Question Title * 3. Do you have Internet? Yes No If yes, with who? Question Title * 4. Current Physical Address: Street City State, Zip Code Question Title * 5. Mailing Address: (if different from above) Street City State, Zip Code Question Title * 6. Do you own or have access to a computer or laptop? Yes No Question Title * 7. Are you currently a SNAP Beneficiary or receiving government assistance? Yes No Question Title * 8. Which campuses do you prefer? (check any that apply) Cheraw Pageland Patrick Marlboro Dillon Online Question Title * 9. What kind of program are you interested in? (Check any that apply) Degrees and Certificates for Transfer to 4 Year College Allied Health: CNA/Phlebotomy - EMT - Nursing Business and Accounting Computer Technology Criminal Justice Culinary Arts Early Care/Childhood Education Engineering Graphics and Technology Heavy Equipment Operations Industrial Maintenance Machine Tool Manufacturing Transportation and Logistics (CDL & Warehousing) Welding Apprenticeship Programs Associate in Arts (AA) - 60 hours Associate in Science (AS) - 60 hours Business Administration (AAS.BUAD) - 63 hours Business Administration - Accounting Speciality (AAS.BUAD.ACC) - 60 hours Done