Adult Basic Skills - Enrollment Form

UCC Adult Basic Skills

Enrollment Form

Thank you for your interest in Adult Basic Skills at UCC!

Please fill out the form below:

Starting Term

Program of Interest

First Name

Middle Initial

Last Name

Phone

Cell Phone

Mailing Address

City

State

Zip Code

Date of Birth (mm/dd/yyyy)

Social Security Number (optional)

Age

Gender

Race / Ethnic Background

Highest Grade Completed

Last School Attended

Highest Diploma / Degree Earned

How are you paying for classes?

Are you a U.S. citizen?

Would you like to be on our email and texting lists?

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Phone: 541-440-4600 | Toll Free: 800-820-5161 | Oregon Relay TTY: 711

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UCC is an equal opportunity employer and educator.
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UCC Adult Basic Skills

Enrollment Form