Counseling and Registration Form

Fill out this form to reserve your orientation date. Thank you.

* All fields required.

First Name :

Last Name :

Birthday :

Postal Address :

City :

State :

Zip :

Phone :

Cellphone : +1

Email :

High School Attended :

Do you plan to transfer Yes No

Major:

Date Requested :

Time Requested :

Contact Information

Address: IVCC Counseling Center

815-224-0360