Malcolm X College West Campus Interest Form

First Name(Required)

Last Name(Required)

Email(Required)

Phone(Required)

Date of Birth(Required)

Street Address(Required)

City(Required)

State(Required)

Zip Code(Required)

Are you a CHA resident?(Required)

Yes

Current High School(Required)

High School Graduation Year(Required)

Semester you plan to start(Required)

I want to...(Required)

Program of Interest(Required)

Opt-in

By providing a phone number I am opting-in to receive text communications from City Colleges of Chicago (CCC). I understand that CCC will not share my information with external organizations.

By providing an email address, I am opting-in to receive email communications from City Colleges of Chicago (CCC). I understand that CCC will not share my information with external organizations.