Request For Information

*Asterisked items are required. Please also note that although we do not require an e-mail address, if you wish to communicate with us via e-mail, you must fill out that part of the form.

*First Name and Last Name:
*Street Address:
*City:
*State:
*Zip Code:
*Telephone H:
Telephone W:
E-mail Address:
*In which associate degree program or programs are you interested?	Not Interested in Degree Program Accounting Automotive Technology Automotive Service Management Business Administration Criminal Justice Culinary Arts Early Childhood Education Environmental Science General Studies Geographic Information Systems Human Services Information Technology Liberal Arts Mobile Equipment Technology Nursing Office Management-Administrative Office Management-Medical Surveying Technology Teacher Preparation Undecided
*In which certificate program or programs are you interested?	Not Interested in Certificate Program Automotive Technology Business Administration Career and Technical Education Child Care Early Childhood Education Entrepreneurship Food Service Production Geographic Information Systems Health Science Technology Human Services Information Technology Medical Assistant Medical Coding Medical Transcription Mobile Equipment Technology Office Assistant Special Education Water Quality Technology Undecided
*For which semester are you interested?	Fall (September) Spring (January) Summer
*For which year are you interested?	2008 2009 2010
Where did you hear about NHCC - Berlin?	Radio Newspaper Website NHCC Admissions NHCC Alumni/Student Guidance Counselor/Teacher Friend Family Member Other
Any questions or comments?