Southeastern Community College - Request Information

Request Information From Admissions

If you would like information on the courses that are offered at Southeastern Community College, please fill out this form and information will be sent to you as soon as possible.

If you would like to talk to an admissions counselor who can answer your questions, call:

NORTH CAMPUS                   SOUTH CAMPUS
West Burlington                    Keokuk    
1-866-722-4692                 1-866-722-4692
1-319-752-2731                 1-319-524-3221

Thank you for your interest in S.C.C.!

* denotes required information.

* First Name:

* Middle Initial: enter 'X' if no middle initial

* Last Name:

Maiden Name:

Gender: Male Female

Social Security Number:

* E-Mail Address:

* Date of Birth:

* Street:

* City:

* State:

* Zip:

Phone: Please include area code

Enter the name of the high school or GED testing center that you have (or will be) graduated from.

* High School/GED Graduation Year (or anticipated):

* Institution Name:

--OR--

* Enter Institution Name:
(if not listed above)

* High School/GED City:

* High School/GED State:

* Graduation Type:

* Send Information On:

* Campus you would attend:

* When would you enroll?

Message: