FOR STUDENT USE ONLY
If you have any questions about this form, please contact the Housatonic Community College Office of Student Life at 203-332-5973.
The State Board of Regents requires all electronic mail correspondence containing FERPA protected information to be done through College-issued email accounts: @hcc.commnet.edu or @housatonic.edu. This office will not correspond using personal email addresses.
When reporting the names below, please indicate if they are students, facuty/staff or other.