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Certification Statement
Certification Statement (required)
I certify that I am who I say I am and I am requesting this information to use to attend HCC.
Certification Statement 2
Certification Statement 2 (required)
I authorize Howard Community College to provide the requested information to the outside agency.
Relationship to the person submitting the questions
I am the parent of a current, prospective, or previous student.
I am a prospective Student.
I am a previous Student.
Other
Student’s Name
Student's DOB
(mm/dd/yyyy)
DOB
(mm/dd/yyyy)
Please tell us your relationship to the person submitting the questions
Phone Number
Semester/Academic Year
Prior to Fall 2025
2025FA (Aug 2025 - December 2025)
2026WS (January 2026 - May 2026)
2026SU (May 2026 - Aug 2026)
OTHER
Short description regarding the nature of your questions
A short description to explain the nature of a ticket.
Attachment
File attachments associated with the ticket.
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HCC will follow the delivery instructions indicated on the form. However, if no instructions are provided, select how you want this information delivered to the agency.
Instructions provided on the form
Mailed
Emailed
Student will pick-up
Other Fields
Your name
Your first name
Your last name
Your email address
Verification Code