Student ID*
First Name*
Last Name*
CCC Email Address*
Please enter your CCC email address ending in @student.clackamas.edu
Phone Number
Where can we reach you?
Please Select Appropriate Department*
Student Upload*
Click to browse
or drag a file here
Attach File
Remaining attachment capacity: 10 files, 20.00 mb
Please attach any completed forms, transcripts, etc.
Authorization*
By checking this box, I authorize CCC to use the information that I have provided to assist me in my requests and certify that I am the student listed above and that all documentation is true and accurate to the best of my knowledge. Additionally, I understand that if I give false or misleading information, I may be fined up to $20,000, sent to prison, or both.
Submit