Application For Admission Form printable pdf download

Nashua Community College

505 Amherst Street, Nashua, NH 03063 • 603-578-8908 •

Application

Fee Waived

Application for Admission

Application Fee: $20.00

Please complete all items and print clearly

GENERAL INFORMATION

______________________________________________________________________________________________________

First

Last

Middle

List other names on school records (Maiden name)_________________________________________________

______________________________________________________________________________________________________

Street

City

State

Zip Code

Preferred method of communication: (Check one) Phone Email

Text

Phone Number________________________________ Preferred Email______________________________________________

Are you a U.S. Citizen?

If No, are you a U.S. permanent resident?

Yes

No

Yes

No

If you are not a legal resident, what is your current visa status?____________________________________________________

Is English your native language?

 No

If No, what is your native language?____________________________

Yes

*FEDERAL GOVERNMENT STATISTICAL INFORMATION (optional)

*Gender:

 Male

 Female

*Date of Birth __________/_________/_________

*Ethnic Background: Are you Hispanic/Latino?

Yes

No

*Race

American Indian or Alaska Native

Black or African American

Asian

Native Hawaiian or Other Pacific Islander

Multi Racial

Race Unknown

White

SOCIAL SECURITY NUMBER REQUIREMENT

Federal law requires that NCC collect names and corresponding social security numbers for all students attending the college. The college is required by the In-

ternal Revenue Code to produce a 1098-T tax form (26 U.S.C.A. Section 6050 or Federal Register, Vol. 67, No. 2244, page 777686 (ii)) which requires the college

to report the names and social security numbers of all students taking credit-bearing courses. Please note, however, that the college will ensure the security of the

student’s social security number and will not disclose it to anyone outside the

college, except as authorized by federal or state laws or applicable policies.

Social Security Number _________-_________-_________

HIGH SCHOOL - GED INFORMATION

______________________________________________________________________________________________________

School Name

City

State

Zip Code

__________________________

Date of Graduation

Year GED Awarded