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Personal Data

Name-Last: First: Middle:
        
Present Address-Street/Box/Route:
 
City/State/Zip: County
             
Social Security No.:         Telephone-Day: Evening: Cell:
 
E-Mail Address:  
We will use this email address to communicate with you about your application status. Once you have officially registered for classes at Hinds, you will be given a personal Hinds email address. This Hinds email addres will be the primary means of communication to you from the college.

Birth Date: (mm/dd/yyyy)
 
I plan to attend Hinds starting:        Year:
        
I plan on attending the following campus for the majority of my classes:

I am   

My Program of study is    Major:

Have you ever attended Hinds Community College?  





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