Request LAC Help

If you see this don't fill out this input box.

I am a ...

Student who needs help

Faculty member referring a student for help

Other NCCC staff referring a student for help

Family member seeking help for a student

Please tell us who you are.

Name of student seeking help or person (faculty, staff, family member) making this referral *Please enter your first and last names.

Name(s) of student(s) being referred (for faculty, staff or family members using this form)

Classes and Subjects*Please provide the subject/class you are requesting LAC help for

Additional InformationPlease use this space to details about your request.

Email contact*Please enter an email address we can use to contact you.

Phone(Area Code)-XXX-XXXX

Which NCCC campus is the STUDENT affiliated with?

Saranac Lake

Malone

Ticonderoga

Not sure