Titan VIP Experience: College of Nursing & Health Sciences (Admitted Students Only)

Please complete and submit at least 30 days before your desired visit date. After you have submitted the form, we will contact you to schedule your visit.

Number of Guests (Admitted Student and up to Two (2) Guests):

Please note children under the age of 13 may not participate.

Student Information

Legal First Name:

Legal Last Name:

Email Address:

Confirm Email Address:

Phone:

Cell Phone:

Mailing Address:

Mailing City:

Mailing State

Mailing Zip/Postal Code:

Mailing County:

Email of Parent/Guardian:

My College Entry Term:

I am a:

If Special/Visiting, please explain:

I am a first-generation college student?

YesNo

If neither of your parents graduated from college, choose yes.

U.S. Armed Forces Status:

Current or Last School of Attendance:

My Program:

What is your long-term educational goal after graduating from Central Carolina Technical College?

Enjoy a meal with us. Do you have special dietary needs?

YesNo

If yes, please explain:

Special Accommodations for Mobility:

YesNo

If yes, please explain accommodations needed:

Contact Information