California Central Coast Community College Collaborative (C6) Student Event Registration Form

Please don't fill out this input box.

Personal Information

Last Name*

First Name*

Middle Initial

Birthdate MM/DD/YYYY*

Phone Number (XXX) XXX-XXXX*

Community College*

If you selected "Other," please list the name of your community college here:

Please check this box if you are a staff or faculty member. Please leave unchecked if you are a student.

Yes, I am a staff or faculty member for the college entered above.

College ID Number*

College Email Address*

Please select the category your major applies to:*

If you selected "Other," please list your major here:

If you are unsure, visit https://www.lsamp.org/help/help_stem_cip.cfm to find your major and category.

Please ensure your college has your current major on file in Admissions and Records.

Please select the Zoom STEMinar(s) you would like to attend:*

My STEM Journey (Wednesday November 20th @ 5 - 6PM)

College Information