EICCD College Credit Information Form

EICCD College Credit Information Request Form

Fill out this form to obtain more information about EICCD. *Required fields.
Name:*

Address:*
Address2:
City:*	State:* Zip:* Country:

Email:*

Telephone:

I plan to begin (or began my program of study):	Spring Summer Fall Undecided 2011 2012 2013 Undecided

I will be (or am) a:	New Student Transfer Student Returning Student Interim Student (I want to transfer credit to my 4-year college/university)

I would be most interested in attending:	Clinton Community College Muscatine Community College Scott Community College Not Sure

Program/Area of Interest:

Comments or Information requested:


The Eastern Iowa Community College District endorses the principle of equal educational opportunities for all people regardless of race, color, creed, marital status, national origin, sex, sexual orientation, religion, ancestry, age, or non-job related handicap or disability in the educational programs or activities it operates. Persons having inquiries concerning the district's accommodation for or compliance with Title VI, Title IX, Section 504, the Americans with Disabilities Act and the Age Discrimination Act may contact: Affirmative Action Officer, 306 W. River Drive, Davenport, IA 52801, (319) 336-3300; Dean of Student Development, Clinton Community College, 1000 Lincoln Boulevard, Clinton, Iowa 52732, (319) 244-7001; Dean of Student Development, Muscatine Community College, 152 Colorado Street, Muscatine, Iowa 52761, (319) 288-6001; Dean of Student Development, Scott Community College, 500 Belmont Road, Bettendorf, Iowa 52722, (319) 441-4001