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Certification Statement
Certification Statement
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
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
2023FA (Aug 2023 - December 2023)
2024WS (January 2024 - May 2024)
2024SU (May 2024 - Aug 2024)
2024FA (Aug 2024 - December 2024)
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