CLOVIS COMMUNITY COLLEGE
Kids' College 2018 Scholarship
Program Application
Name (Last, First, Middle) Name of Parent or Guardian
Mailing Address/Street or P.O. Box City/State Zip
Best Phone (Cell/Work/Home)
Alternative Phone (Cell/Work/Home)
Email Address
If an e-mail address is listed it will expedite notification
Al Potthoff
Clovis Community College Business &
Non-Credit Training 417 Schepps Blvd,
Clovis, NM 88101 Phone: (575) 769-4760
Fax: (575) 769-4190
http://www.clovis.edu/noncredit
1. List any courses you would like to take and tell us why.
OR
2.
Tell us about a course you would like to see offered in the future.
Mail, E-mail or fax completed form to: