First Year Success Program Student Information Card
Cuyamaca College
900 Rancho San Diego Parkway E Cajon, CA 92019-4304
www.cuyamaca.edu          (619) 660-4523

Last Name:    First Name:     Middle Initial:

Address:

City:   State:     Zip: Area code:     Phone #:

E-mail address: @. com net edu     Gender: Male Female

Name of High School Attended:

May we contact you by telephone? Yes  No

May we contact you by email? Yes  No

Do you have any questions about the program?