CCCC Application for Admission
Welcome to Cloud County Community College! Begin your journey by submitting your application today!
*Notes for form administrators:
File Extensions - Before files can be processed into EX, allowed file extensions must be made available to the Admissions Candidacy Essay Attachment Use Code in the Make File Extension Available for Attachment window.
Attachment Mapping - Before the form will successfully process into EX, mapping will need to be updated for each of the Candidacy Attachment rows to ensure that the ATTACHMENT_CDE values are valid attachment types and are associated with the AD_CANDCY Use Code in the Attachment Type Definition window in EX.
Relationship Mapping - Before the form will successfully process into EX, mapping will need to be updated for each of the Relationship Information rows to ensure that the REL_CDE values are valid relationship codes defined in the Relationship Definition window in EX.
Waiver Codes - The waiver code question has been associated with the Waiver Codes data source. The example is a hard coded data source. In a real-world example, it would be best to store these waiver codes in a custom table.
Payment Profile - The payment profile for this form has been associated with the submit button. The transaction code should be updated to a valid AR_CDE defined in the EX Receipt Code Control window.
Mapping Information - This form contains default mappings for questions existing on the form. Some client-specific values, like Candidacy Stage and Type, may be desired and can be added by modifying the mapping and entering a custom value for the specified column.
Preferred First Name
What is your birth/maiden last name?
Birth Date (MM/DD/YYYY)
Confirm Email Address
If you are here on a visa, what type of visa is it?
Do either your mother or father have a bachelor's degree (4-year degree)?
Race (Choose one or more)
Are you Active Military/Veteran or a dependent?
Do you reside outside of the United States?
Address Line 1
Address Line 2
County (Kansas Only)
I have been a resident of this state since (MM/DD/YYYY)
Primary Phone Number
In order for Cloud County to send you text messages, we much first be given permission to do so and must also know who your cell phone provider is.
Does Cloud County Community College have permission to text you regarding important information? (Your standard text messaging rates apply)
Which cell phone service provider do you use?
If you selected "Other", please enter your cell phone provider
Will you be receiving Veterans benefits?
Do you qualify for benefits as:
Where will you primarily be attending classes?
Are you interested in living in on-campus housing?
Please select the option that best describes you:
*To be eligible for Financial Aid, you must be seeking a degree offered at CCCC.
What year do you plan to begin your studies?
What term do you plan to begin your studies?
What type of student will you be?
What is your field of study?
Emergency Contact Information
Emergency Contact Name
Please provide your high school information (with graduation year) and any previous college you have attended.
Select the state, city & institution. If your school is not listed, select “School Not Listed” & type the name into the “Name of Institution” field.
Once you have entered your school information, select “Save this school” and repeat the steps until all schools have been entered.
State of Institution
City of Institution
Name of Institution
HS or CL?
Year of graduation (HS only)
Use the dropdown below to choose extracurricular activities that interest you.
Use the "submit" button below to finalize your application.