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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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