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PRCC Online Application Verification Form

This form must be filled out and mailed in for your online application for admission to Pearl River Community College to be valid.  Print it, fill it out, and mail it to PRCC along with an official copy of your high school transcript (also all official college transcripts, if applicable) and a photo copy of your original ACT scores to:


Pearl River Community College
Admissions Office
Box 5559
101 Highway 11 North
Poplarville, MS  39470

(ph. 601-403-1214)



Today's Date:

Name:

Address:

City:

State:

Zip:

Social Security Number:

This form verifies the application I submitted online on (date:                           ).  I verify that the application submitted was a correct and true statement.
 

Signed:


(please sign your name as it appears on the online application)



NOTE:  If you would like additional information, please fill out the online questionnaire.



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© 2008 by Pearl River Community College
Office of Public Relations
All rights reserved.
PRCC
101 Highway 11 North
Poplarville, Mississippi 39470
601-403-1000
E-mail