Application For Admission Form Page 2
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321. If you answered credit classes or both on question #20, do you plan to pursue a degree, certificate or diploma?
Yes
No
If yes, then Identify your plan of study (refer to the college's list of plans): __________________________________________________
(include sub-plan, if applicable)
If no, then go to #22.
(Financial Aid students must check yes and enroll in an approved plan of study.)
22. If you answered no to #21, which of the following best describes your reason for taking classes?
(Check only one)
_____ Upgrading job skills
_____ Developing job skills
_____ Exploring career options
_____ Pursuing personal interest
_____ Currently pursuing degree
_____ Planning to pursue a
or general knowledge
at another college
degree at another college
(transient/visitor)
(non-degree/transfer)
_____ Pursuing college courses while in high school
23. What campus do you plan on attending? _____________________________________________ (if applicable)
24. Secondary Education
Type:
( ) High School
( ) GED Program
( ) Home Schooling School/Agency Name: _______________________________________________
Located in: _________________________________________
______________________
____________________________
City/County
State
Country
Non-graduate
Graduated – Date: _____________ Plan to Graduate – Date: ______________
Highest grade completed: _______________________
mm/yy
mm/yy
mm/yy
25. Colleges/Universities Attended
If you have taken any college classes, please list all colleges attended with most recent first.
Indicate any degrees earned in the last column with an A for Associates, B for Bachelors, M for Masters, D for Doctorate, or
P for Professional Degree. If you have not earned a degree, leave the Degrees column blank.
College or University
City, State/Country (if not USA)
Years Enrolled
Degrees
I certify under penalty of disciplinary action that all of the information is complete and accurate.
I agree to supply the college with supporting documentation related to my application,
if I am requested to do so.
Applicant's Signature: ____________________________________________________________
Date: _____________________
Parent/Legal Guardian's Signature:
________________________________________________
Date: _____________________
(if under 18 years of age)
This institution promotes and maintains educational opportunities without regard to race, color, ethnicity, religion,
sex, age (except when age or sex is a bona fide occupational qualification), handicap, national origin, marital status,
veteran status, political affiliation, sexual orientation or other non-merit factors. Employer, date of birth, social security,
sex, and race information are optional and used for research, reporting and management of student records.
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