Blackhawk Visit Day Registration Form Keokuk Campus
Name
*
First Name
Middle Initial
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email Address
*
example@example.com
Confirm Email Address
*
example@example.com
Mobile Phone Number
*
-
Area Code
Phone Number
High School
*
Graduation Year
*
Program of Interest
*
Associate of Arts
Associate of Science
Advanced Technology, Construction & Welding
Agriculture Studies
Automotive Technology
Business Management & Administration
Education
Health Professions
IT & Multimedia
Industrial Maintenance
Undecided
Other
Which day would you like to attend?
*
September 20, 2022
November 11, 2022
February 20, 2023
April 28, 2023
Please check any additional opportunities to add to your Visit Day
Meet with faculty one on one
Meet with financial aid
Take/schedule placement testing (testing not available on Friday Visit Days)
T-Shirt Size?
*
How did you here about SCC Visit Day?
*
Submit
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