Southeastern Community College

Request Information From Admissions

Want to learn more about SCC? Complete this form and we will send you some information.

Don't want to wait for the mail? Talk to an Enrollment Specialist:

West BurlingtonKeokuk

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

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* 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:


* Enter Institution Name:
 (if not listed above)

* High School/GED City:

* High School/GED State:

* Graduation Type:


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* Campus you would attend:

* When would you enroll?