Community Education Application
For more information and to pre-register for a non-credit course, please fill out this form with your name, contact information and the course you would like to attend.
Cloud County Community College does not discriminate in admission or access to, or treatment in employment in its services programs or activities on the basis of race, color, national origin, sex (including pregnancy, sexual orientation, or gender identity), religion, age, disability, or veteran status.
*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
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
What year do you plan to begin your studies?
What term do you plan to begin your studies?
Which type of course do you intend to participate in?
Use the "submit" button below to finalize your application.