Columbus State Community College AM

All fields with an * are required.

- * First Name
- Middle Name
- * Last Name
- Suffix
- * Gender
- * Date of Birth
  
  [mm/dd/yyyy]
- * Email Address
- * Preferred Phone Number
- Cell Phone (if different from preferred)
- In case we can't get in touch with you directly, is there someone else we can reach out to? This could be a parent/legal guardian, a partner or spouse, a close friend, or someone else that should be able to get ahold of you.
- Alternate Contact Name
- Alternate Contact Phone
- Alternate Contact Email
- * Do you consider yourself to be Hispanic/Latino?
- * Please select one or more races to describe yourself. Hold down the CTRL key to select more than one option.
- * Are you currently employed?
- Who is your employer?
- Healthcare is one of the fast growing industries in the country, and it offers many different career paths. The Health Careers Opportunity Program is part of a national grant program aimed at helping students from disadvantaged backgrounds enter health professions. Columbus State offers associate degrees in many high-demand fields, including respiratory care, medical imaging, and dental hygiene. The Health Careers Opportunity Program at Columbus State offers educational summer camps for high school students and entering Columbus State freshmen, as well as scholarships for students participating in a health care major.
- How can HCOP help you?
  Tutoring
  
  Math
  
  Science
  
  English
  
  Social Studies
  
  Reading
  
  Counseling
  
  Study Skills Instruction
  
  Make better grades
  
  Social Counseling
  
  Personal Counseling
  
  Time Management
  
  Cultural Activities
  
  Future Planning
  
  Career Planning
  
  Postsecondary Education Information
  
  Find Scholarships for College
  
  College Visits
  
  Financial Aid
- * Is there anything may prevent you from going to and succeeding in college? (at least 50 words)
- * Why do you want to be in the HCOP Summer Bridge Program (PMAP) at Columbus State Community College? (at least 75 words)
- * Are you able to attend an online 2-week program with Columbus State Community College next summer?
Contact and Case
- Prospect Area of Interest
Radius Lead Source
- Radius Lead Source

Contact and Case

Radius Lead Source