HCCC/NJCU: CONNECT Declaration Form

Thank you for your interest in the HCCC|NJCU CONNECT program! Please complete this form, and a Transfer Success Coach will contact you.

First Name

Chosen Name

If your chosen name is different than your legal name, please share it here.

Last Name

HCCC Student ID Number

Cell Phone Number

Phone

HCCC Email Address

Please share your HCCC email address.

Birthdate

mm/dd/yyyy

Street Address

City

State

Zip Code

Current Major

What is your current major at HCCC? Please choose from the list of CONNECT program majors.

CONNECT Pathway Choice (NJCU Program)

Which Bachelor's degree are you interested in pursuing at NJCU? Please choose from the list of CONNECT program majors.

Current GPA

If you know your current cumulative GPA, please share it here.

Consent to share HCCC information with NJCU

As part of the CONNECT program, HCCC and NJCU will share information to help streamline your transfer process. By clicking this button, you are consenting to information sharing.

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