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Lakeland Community College




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Information To receive additional information on degree and certificate programs for college credit, please complete the following.
For all other interests, including Lakeland's Holden University Center, click here.

Required - indicates a required field.
Prospect Name
First Name: Required
Middle Name:
Last Name: Required

Primary Address
Address Line 1:Required
Address Line 2:
State or Province: Required
ZIP or Postal Code:
Phone Number: Required () Format: (999) 9999999

E-Mail Address
E-mail Address:Required
Confirm E-mail Address:Required

Prospect Birthdate
Date of Birth:Required Month Day Year (YYYY)

Information To make multiple selections, hold Ctrl key (PC); command key (Mac)

How Prospect Learned About Us
How I Learned About Lakeland Community College:

Information It is recommended that you use the "Look Up High School Code" link if you attended a High School in the area.

Prospect High School
Home Schooled (check for yes):
High School Code:
High School Name:Required
State: Required
ZIP or Postal Code:
Graduation Date: Required Month Day (YYYY)

Information Enter the anticipated term of entry into college.

Prospect Entry Term
Term of Entry:

Information To make multiple selections, hold Ctrl key (PC); command key (Mac)

Prospect Interests

Prospect Ethnicity/Race
Note What is your ethnicity?

Hispanic or Latino
Not Hispanic or Latino

Note Select one or more races to indicate what you consider yourself to be.

American Indian/Alaskan Native
Black/African American
Hawaiian/Pacific Islander

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Release: 8.7.2