CCS Foundation

Full Name (First, MI, Last)*:

Name while attending CCS:

Student ID Number (If known):

Address*:

City*:

State*:

Zip*:

Phone Number:

( )  -

Birthdate (MM/DD/YY)*:

E-Mail Address*:

Date graduated or last attended*:

Program/Major*:

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

Please select your campus*:

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

Employer:

Occupation:

Which sport (if any) did you play for CCS?:

Please Select the Sport Baseball Basketball Cross Country Football Golf Soccer Softball Tennis Track Volleyball

  If so, please name scholarship(s).:              

Please Select Postcard Brochure E-mail Event Friend Other    Other, please explain:

Spouse's Full Name:

Birthdate (MM/DD/YY):

( )  -

Spouse's E-Mail:

Did he/she attend CCS:

Select Yes/No Yes No

Spouse's Name While Attending:

What year did he/she last attend:

Which campus did he/she attend:

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

Program/Major:

Degree(s) earned (Cert, AAS, AA):