County College Application

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First Name *

Last Name *

Mailing Address *

City *

State *

Zip Code *

Contact Phone Number *

Email Address

How long have you lived in Deschutes County?

Please tell us a little about yourself

Personal History: Please tell us a little about yourself (i.e. accomplishments, interests, community involvement)

What do you hope to learn?

Please tell us what you hope to learn as a participant of County College and how you anticipate using the information.

Are you a current or past member of any Deschutes County advisory boards?

If yes, please list them all.

Are you a Deschutes County employee?

If yes, which department do you work in?

Do you have any ADA needs that we can assist with?

Yes

Do you have any dietary restrictions?

Yes

Dietary restriction details

Please explain your Dietary Restrictions so that we may accommodate you as best as possible.

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Contact Information