Date: 

Name of counselor you prefer to handle your request:

Anyone Stephanie Altamirano Elaine Cole-Abinleko Deborah Jordan Claretha Lacy Dorothy Ray James Steadman Charles West John W. Wheelous  

Last name:    First name: 

Middle/Maiden name: 

Other name record may be under: 

Phone No.:  E-mail address:

Please select only one of the following categories:  

Currently enrolled (enrolled now in course(s) at FTCC Returning student (have taken course(s) at FTCC) New student (never taken course(s) at FTCC)

If you selected "returning student," then please tell us when you were previously enrolled:  semester:  and year:  .

Notes:  

• If you have not completed an application within the past year then you must complete an application by calling (910) 678-8274.  
• If you have not taken the placement test within the past two (2) years then please call (910) 678-8417 to schedule a placement test.  
• If you have not sent to us all of your high school or GED and college transcripts then please do so before a counselor may help you.   

Please select the area(s) in which you need assistance:

Program approval (student education plan) Curriculum change (change in student education plan) Copy of current SEP (student education plan) Retesting card College Transfer Personal counseling Placement test scores interpreted Other

Please type a brief description (in your own words) of the services you are requesting:

Remember that the information you submit is not confidential!