Thank you for your interest in the

Re-entry Connect Program. In efforts to improve our

program and to better meet the needs of our students,

we invite you to complete this intake form.

All responses are confidential and will only be utilized by the Re-Entry Connect program.
* First Name
0/50
* Last Name
0/50
* Fullerton College ID Number *Please include "@" before your ID number, If you do not have an ID number assigned, please write N/A*
0/50
* Email Address
0/50
* What is your preferred method of communication? Please check all that apply.
0/250
* What is your status at Fullerton College?
* The Re-entry Connect Program is designed for non-traditional students. Please check all the ways you meet the non-traditional category:
* Are you part of a student program at Fullerton College? Example: EOPS, DSS, Veterans, SDSI, etc.
* Please check all services you are interested in:
0/250
* When would you be available to attend events/workshops during the semester? (check all that apply)
0/250
* Are you available for: (check all that apply)
* Are you working?
* Are you planning on becoming a:
* Do you have an intended major at Fullerton College?
0/250
* What is your main goal at Fullerton College?
0/250
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