EICCD Request Printed Material Form

Fill out this form to obtain more information about EICCD.     Fields with a  *  are required.   1.   * First Name:       * Last Name:      2.   * Street Address:       Street Address 2:       * City:     * State:         * Zip Code:     Country:      3.   * E-mail Address:          (please include your area code) 4.   * Telephone:      5.  I plan to begin (or began) my program of study:     Spring      Summer      Fall      Undecided     2006      2007      2008      2009      Undecided     6.  I will be (or am) a:     New College Credit or Career Technology Student     Transfer Student     Returning Student     Interim Student (I want to transfer credit to my 4-year college/university)     Continuing Education Student     7.  I would be most interested in attending:     Not Sure     Clinton Community College     Muscatine Community College     Scott Community College     Information Requested Please send me:   Credit Class Schedule   Continuing Education Class Schedule   Application Packet   Financial Aid Information   Health, Safety and Environmental Technology Registration Packet   Distance Education Options - Internet, ICN, TIE and Telecourses   Information For International Students     Comments or additional 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, (563) 336-3300; Dean of Student Development, Clinton Community College, 1000 Lincoln Boulevard, Clinton, Iowa 52732, (563) 244-7001; Dean of Student Development, Muscatine Community College, 152 Colorado Street, Muscatine, Iowa 52761, (563) 288-6001; Dean of Student Development, Scott Community College, 500 Belmont Road, Bettendorf, Iowa 52722, (563) 441-4001.