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CCCApply

Supplemental Questions

Jira Legacy
serverSystem JIRA
serverId8b861ae3-ff87-316b-a17e-97c61a7e2fb4
keyAP-658

...

Question

Field Name

Field Type

Banner Integration

First Name

Text box

Note

Unvalidated; user can enter blatantly false data.

Info

Required field

Last Name

Text box

Note

Unvalidated; user can enter blatantly false data.

Info

Required field

Area Code

Text box

Note

Unvalidated; user can enter blatantly false data.

Info

Required field

Phone

Text box

Note

Unvalidated; user can enter blatantly false data.

Info

Required field

Extension

Text box

Note

Unvalidated; user can enter blatantly false data.

Info

Required field

Address Line 1

Text box

Note

Unvalidated; user can enter blatantly false data.

Info

Required field

Address Line 2

Text box

Note

Unvalidated; user can enter blatantly false data.

Info

Required field

City

Text box

Note

Unvalidated; user can enter blatantly false data.

Info

Required field

Zip

Text box

Note

Unvalidated; user can enter blatantly false data.

Info

Required field

Their relationship to you:

Dropdown:

  • Mother

  • Father

  • Spuse

  • Brother

  • Sister

  • Ex-spouse

  • Grandparent

  • Relative

  • Guardian

  • Domestic Partner

  • Significant Other

  • Child

  • Doctor

  • Employer

  • Neighbor

  • Friend

State

Dropdown

States (and Territories, Armed Forces)

Countries

Dropdown

Current Math Class

The following question will help us place you in the most appropriate Math class.

Question

Field Name

Field Type

Banner Integration

If you are taking a math class currently, which class is it?

Dropdown

  • Pre-algebra or lower

  • Algebra 1

  • Integrated Math 1

  • Integrated Math 2

  • Geometry

  • Algebra 2

  • Integrated Math 3

  • Statistics

  • Integrated Math 4

  • Trigonometry

  • Pre-Calculas

  • Calculus or higher

  • None of the Above

  • I am not currently taking a math class

...