CCS Foundation

Full Name:

Name while attending CCS:

Address:

City:

State:

Zip:

Phone Number:

( )  -

E-mail Address:

Birthdate (MM/DD/YY):

Employer:

Occupation:

Spouse's Full Name:

Spouse's Birthdate:

Spouse's E-mail:

Did he/she attend CCS:

Yes/No Yes No

If so, what year did he/she graduate:

Program/Major:

What campus did he/she attend:

Select Campus Spokane Community College Spokane Falls Community College Both SFCC and SCC Institute for Extended Learning-Spokane IEL-Colville IEL-Inchelium IEL-Newport IEL-Republic IEL-Whitman County Extension IEL-Other Unknown

Degree(s) earned (i.e. Certificate, AAS, AA):

Comments/Other Information: