Contact Form

WARNING for SLBC Moodle students:
If you submitted a multi-part Application form and were issued a
User Name and Password DO NOT USE THIS FORM! You are
registered with our automated site at http://slbcrecords.org
and all of your tests, forms, and other communications must
be with that site directly and not through this current site.
If you are a SLBC Moodle student and submit this form,
it will be Disallowed and discarded and cannot be
placed in your Moodle-enabled academic file.

Only those students who were NOT ISSUED a User Name
and Password are allowed to use this current form.

Please fill out the following information and click the submit button.
"*" indicates mandatory fields.
*First Name:
First Name is defined as your given name. Not your family name.
*Last Name:
Your Last Name is defined as your family name. Not your given name.
*Email:
*Verify Email:
*Address1:
Address2:
*City:
*State, Province, etc.:
Other:   This field is to signify what State or Province or other division as used in your country to signify the particular portion of your country in which you live.
Zip Code (if any):
*Country: Other:  
Phone:
( )   - Ext.
Cell:
( )   -
Fax:
( )   -
*Comments:

ATTENTION:
The following fields are for current students only.  If this contact is concerning a test, a form, or it is your response to a communication from the college, please give detailed information (name of course, test #, name of form, subject of your response to our communication to you, etc.)  If you do not give detailed information then we will not be able to handle your request.

Concerning:
Test Form Access to course Communication received from SLBC Other:
Name of Course (if applicable): Other:  
Lesson or test number (if applicable): Other:  
Name of Form: Other:  

Attention: If you are a registered student, please read and follow these instructions.
If you are not a registered student, skip these instructions and go on to the next question.
If you are a registered student, you are required, as part of your training, to use proper
letter-case and proper sentence structure and punctuation in all submissions to the college.
This includes in all forms, tests, email, and all other communication sent to the college.
If you are a registered student, indicate so in the next section.  If you have used proper
letter-case and proper sentence structure and punctuation, then click the Yes box.
If you have not done so, click the No box.  If you do not use proper letter-case
and proper sentence structure and punctuation then this form will be disallowed
and you will have to correct it and resubmit it.  Please set your email to
automatically run a spell-checker on all out-going mail.  This is a
college and the students are expected to do college level work.

*Are you a registered student?
Yes. No.
If you are a registered student, did you use proper letter-case, spelling, and punctuation on this form?
*
Yes. No. Not a registered student.
If you need to include files with this form, please do so in the next field.
Upload Files (max is 1mb per file)
Select a file and click 'Add':

File(s) selected for upload:


*I am not a robot.
Yes