KCC Dual Credit App
About You
This application will take approximately 10 minutes to complete. You will need your email address and your phone number.
Names & Demographics
First Name
Middle Name
Last Name
Previous Last Name
Preferred name
Gender
Marital Status
Birthdate
Ethnicity & Race
To comply with federal statistical reporting requirements, Klamath Community College must seek to identify the racial and ethnic background of applicants. You are encouraged to to supply this information, but your application will be given the same consideration whether or not you do so.
Ethnicity
Race (Choose one or more)
White
Native Hawaiian or Other Pacific Islander
Black or African American
Asian
American Indian or Alaska Native
Contact Information
Address
Country
Street
City
State or Territory
Please select...
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PT
PZ
QC
RI
SC
SD
SK
TN
TT
TX
UM
UT
VA
VI
VT
WA
WI
WV
WY
YT
State/Territory
Zip/Postal Code
County
Are you a legal resident of OR, CA, WA, ID, or NV?
For Military personnel, base this on your home of record
Phone & Email
Mobile Phone Number
10 digits. NO Country code, spaces, or special characters.
Secondary Phone Number
Personal Email Address
example: johndoe@gmail.com, or johndoe@yahoo.com
Confirm Email Address
Email
Confirmation OK
Email
Confirmation Error
Course Information
Course Information
When do you plan to start?
High School Name
Have you ever had an IEP or 504 Plan?
Please select...
Yes
No
Hidden fields
HS Course Title
KCC Course Title
KCC Instructor Name
KCC Course Code
Academic Start Term Id
High School Id
HS Program Id
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Having trouble with this form? Send us an email at admissions@klamathcc.edu