Community Hub Student Inquiry Form

Please let us know how we can help you! A Community Hub representative will follow up with you by phone or email! If you need immediate assistance, please feel free to stop by the Community Hub in the Moffat Student Center Café!

Student Name (First and Last)

Pronouns

Examples: he/him, she/her, they/them, ze/zir, etc.

Student Inquiry Date

Campus Location

County of Residence

Carbon
Lackawana
Luzerne
Monroe
Pike
Susquehanna
Wayne
Wyoming
Columbia County

Program of Study

Architectural Drafting & Design Tech. (ADT)
Advanced Manufacturing Tech. (AMT)
Automotive Tech. (AUT)
Aviation Tech. (AVT)
Biomedical Equipment Tech. (BET)
Building Property Maintenance Certificate (BPM)
Carpentry & Cabinetmaking Tech. (CCM)
Civil Design (CDT)
Computer Information Tech. (CIT)
Diesel Truck Tech. (DTT)
Diesel Prev. Main. Certificate (DPMT)
Electrical Construction Tech. (ECT)
Electronic Engineering Tech. (EET)
Heating Ventilation Air Conditioning Tech. (HAC)
Heavy Equipment Tech. (HET)
Industrial Tech. (IND)
Mechatronics Tech. (MEC)
Physical Therapy Assistant (PTA)
Radiologic Tech. (RAD)
Veterinary Nursing (VEN)
Welding Fabrication & Manufacturing Tech. (WFT)
Welding Tech. Certificate (WTC)
Dual Enrollment / IFT Students

Potential Graduation Year:

Services or Information Requested

Please let us know how we can help you! If you need assistance with something not listed here, please select "Other" and use the text box below to provide any details!

Additional Information

Please use this space to provide any additional information or ask any questions you may have!

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Details/Resources Provided

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Contact Number

Johnson Student Email

Preferred Contact Method

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