This publication was created by the CCAC Public Relations & Marketing Department. Solomon Request for Information-P-POD-SLK-AUG17
Ofce of the Registrar
Solomon Amendment Request for Information
Return this form along with written request on military letterhead to:
CCAC Registrar
800 Allegheny Ave
Pittsburgh, PA 15233
Fax: 412.237.3194
Name of Contact Person: _________________________________________________________________________
Organization: ___________________________________________________________________________________
Address:
________________________________________________________________________________________
________________________________________________________________________________________________
Phone Number: _______-_________-______________ Request Date: ____________________________________
Selection Information:
Semester Data Requested: __________________ (current or previous Fall/Spring only)
_____ All students OR First-Year _____ Sophomores _____
_____ Graduated students (Available for previous semester requests)
_____ Age Range (identify age range, must be 17 or older)
Campus: (multiple campus lists may be selected)
_____ Allegheny Campus
_____ Boyce Campus
_____ North Campus
_____ South Campus
_____ All locations
Information will be provided in Excel le via encrypted email or secure le share platform:
I understand the information released is limited to military recruiting purposes only. This information will not be
shared with other parties and data must be destroyed once it has been used. Information provided will be limited to:
• Name
• Age
• Address and Phone Number
• Class Level (e.g. First-Year, Second Year)
• Program/Major
• Degree Awarded
Email address of recipient: ________________________________________________________________________
_____ Homewood Brushton Center
_____ Braddock Hills Center
_____ West Hills Center
_____ Washington County Center
