Application For Admission Form (Page 2 of 2) in pdf

ACADEMIC PROGRAM

What semester do you wish to begin your studies?

Year______

Fall

Spring

Summer

Applying for:_____________________________

Associate Degree

Certificate

(see catalog on website for list of majors)

Day

Evening

Full-time

Part-time

Student Type:

First-Time Freshman

Previous NCC Student

Running Start Participant

Transfer

Are you applying for academic amnesty? (see college catalog)

Yes

No

EDUCATIONAL GOALS

Select one of the following responses which most closely matches your reasons/goals for attending Nashua Community College.

 Complete a certificate program

 Obtain an associate degree

 Transfer to a 4-year college or university

 Obtain or update skills

 Self-improvement/personal enjoyment

 Change careers

RESIDENCE INFORMATION

 I have always lived in New Hampshire OR ________________________________________________________

Month and Year Moved to New Hampshire

______________________________________________________________________________________________

Previous address if residency is less than one year in New Hampshire - City, State, Zip

NEW ENGLAND REGIONAL STUDENTS PROGRAM (NERSP)

The New England Regional Student Program enables a resident of a New England State to enroll in a public college or university in the six state region at reduced

rates for certain degree programs if:

• The program is not available in the home state public institutions, and/or

• The out-of-state public institution is nearer to the student’s residence than the in-state institution that offers a similar program.

NEW ENGLAND STUDENT WHO WISHES TO BE CONSIDERED FOR NE REGIONAL

I am a resident of:

______________________________________________________________________________________

Town or City

State

Academic Major

DUAL ADMISSION PROGRAM in conjunction with University System of New Hampshire

1. I request enrollment in the dual admissions program between Nashua Community College and (you may select more than one).

University of New Hampshire - Durham UNH - Manchester Plymouth State University Granite State College Keene State College

• By doing so: I authorize both Nashua Community College and any designated schools to release an official copy of my transcript and any other relevant student

information to each other for the purposes of Dual Admissions.

• I understand this request for Dual Admissions and Release of Information in accordance with the Family Education Rights and Privacy Act (FERPA) shall

remain in effect at all times when I am an active student at either Nashua Community College or any other University System school should unless they are

notified otherwise in writing.

2. Have you ever been suspended, placed on probation, or dismissed from any school for any academic or disciplinary reasons or incurred other formal

disciplinary action?*

Yes No

3. Have you ever been judged guilty or convicted of a misdemeanor, felony or other crime?*

Yes No

(Note: You are not required to answer “yes” or provide an explanation if

the criminal judgment or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise ordered by a court to be kept confidential.)

If you answered “yes” to either or both questions, please attach a separate sheet that gives the approximate date of each incident, explains the circumstances,

and reflects on what you learned from the experience.

* Any changes in these conditions will require you to notify the Office of Admissions within 14 days.

TO BE SIGNED BY ALL APPLICANTS

The information provided by the applicant on this admission application form shall be held confidential to the extent determined by Federal Law and College policy.

Nashua Community College reserves the right to deny admission to any applicant who, in the judgment of the College officials, does not qualify for admission. The

College also reserves the right to require withdrawal of any student who does not satisfy the ideals of citizenship, character or scholarship.In accordance with the

terms and conditions set forth in its publications, and if accepted to abide by the rules and regulations set forth in the publications and in the Student Handbook, I

also agree that the College has permission to use any College sponsored pictures in which any likeness appears.

I certify that I have read and agree with the above, and that all information provided herein is true and complete.

__________________________________________________________________

________________

Signature

Date

__________________________________________________________________

________________

Signature of Parent

Date

(if student is under 18 years)

NOTE REGARDING ADMISSION REQUIREMENTS

It is your responsibility to request that official transcripts be forwarded directly to the NCC Admissions Office. Some programs have additional, specific admis-

sion requirements which are listed on the academic program pages of the NCC Catalog. Applicants are responsible for knowing these requirements, any specific

deadlines, and submitting appropriate documents as noted. Nashua Community College reserves the right to change tuition, fees, courses, policies, programs,

services, personnel, and admissions criteria as required.

Application For Admission Form Page 2

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