Request a Visit

First Name*

Last Name*

Birthday

Email*

Phone Number*

Address*

Preferred Contact (choose one)*

Email

Phone

High School*

High School Graduation Year*

Are you a first generation student? *

Yes

No

Which campus(es) would you like to visit? (can choose multiple)*

McCook

North Platte

Broken Bow

Imperial

Ogallala

Valentine

Top Three Colleges*

Top Three Hobbies*

Your preferred dates and times are not confirmed. You will receive a follow-up email with
additional information and confirmation of your campus visit date, based on availability.

Intended Career or Major*

Other comments or requests

Are you being recruited to an MPCC Athletic team? *

Yes

No

Has an official MPCC coach been in contact with you to recruit you as part of a an athletic team with a scholarship offer? If not, please select no.

If you answered yes, which athletic team is recruiting you?

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McCook Campus

McCook - East Campus

North Platte - North Campus

North Platte - South Campus

Broken Bow Campus

Imperial Campus

Ogallala Campus

Valentine Campus

Benkelman Learning Center