Interactive Questionnaire

You've got questions?

Fill out this form.  Include your question at the bottom.  Be sure to fill in your email address for our response.  Make known any requests you may have.  If you have questions that need a voice response, you may call our Department of Recruitment and Orientation at 601-403-1197, (you may wish to contact us by emailing us),  or if you require a mail response, write to:

Department of Recruitment and Orientation
P.O. Box 5096
101 Highway 11 North
Poplarville, MS  39470

phone 601-403-1197


First Name

Middle Initial

Last Name



State Zip

Email Address

Phone Number (optional)

Please select your area of interest


If you selected Academic, please specify the field of interest

If you selected Technical, please specify the field of interest

If you selected Career/Technical, please specify the field of interest

Please send me the following information

General Information Package
Financial Aid Consumer's Guide
PRCC Catalog
Scholarship Information
Admissions Application
Housing Application & Info Sheet
General Brochure

Please specify if any of the following applies to you:

Freshman in High School
Sophomore in High School
Junior in High School
Senior in High School

Name of High School

Number of years since you attended high school:

5 years
6-10 years
over 10 years

Will you...
Transfer from another college

Name of college

I would be interested in participating in the following:

Women's Softball
Modeling Team
Flags (band)
S.P.A.R.C. (student host/hostess organization)
RiverRoad (Show Choir)
String of Pearls (Dance Team)
Annual Staff (Compact Disk Yeardisk)
Newspaper Staff

Some students may qualify for support services.  If you are financially disadvantaged, if you have a disability, or if neither of your parents graduated from a four-year college, you may qualify.  Do any of the above apply to you?

yes, at least one of the above applies to me
no, none of the above applies to me
not sure

Any questions we didn't answer?

Please enter your question in the box below.  Make sure that you included your email address for a response.  If you have a specific department or instructor you would like this question directed to, please specify.  If you requested printed information, please make sure that you entered your physical mailing address (PO Box or street address).

© 2008 by Pearl River Community College
Office of Public Relations
All rights reserved.
101 Highway 11 North
Poplarville, Mississippi 39470