Application For Admission Page 3
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4Application for Admission
INSTRUCTIONS: Please print clearly in ink and be sure to answer each question. All documents submitted to Navarro
College to meet admission and residency requirements become part of the official files and cannot be returned.
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Have you ever attended Navarro College?
No
Yes Dates of Attendance: _________________________________________________
Name:
________________________________________________________ ___________________________________________________ ___________________________
Last name
First name
Middle initial
Other name(s) used on documents (Example: maiden name): _________________________________________________________________________________________
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Social Security Number: ________ – _______ – __________
Gender:
Male
Female
Date of birth: __________ ________ _____________
Month (MM)
Day (DD)
Year (YYYY)
Physical address:
________________________ __________________________________________________ ___________________________________________________________
House number
Street, route, apartment number (NO P.O. Box )
E-mail address
____________________ __________________ ____________ __________ _______________________ ________________________ ________________________
City
County
State
Zip
(Area code) Home phone number
(Area code) Work phone number
(Area code) Cell phone number
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Mailing address:
Same as physical address
________________________ __________________________________________________ ___________________________________________________________
House number
Street, route, apartment number (NO P.O. Box )
E-mail address
____________________ __________________ ____________ __________ _______________________ ________________________ ________________________
City
County
State
Zip
(Area code) Home phone number
(Area code) Work phone number
(Area code) Cell phone number
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Permanent address:
Same as physical address
________________________ __________________________________________________ ___________________________________________________________
House number
Street, route, apartment number (NO P.O. Box )
E-mail address
____________________ __________________ ____________ __________ _______________________ ________________________ ________________________
City
County
State
Zip
(Area code) Home phone number
(Area code) Work phone number
(Area code) Cell phone number
Name of person to contact in case of emergency: _________________________________________________________ __________________________________________
(Area code) Telephone number
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Have either of your parents received a college degree?
Yes
No
I don’t know
Ethnicity & Race
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Are you Hispanic or Latino?
Yes
No
(a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race)
Please select the racial category or categories with which you most closely identify. Check as many as apply.
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Asian
American Indian or Alaskan Native
Black or African American
Native Hawaiian or other Pacific Islander
White
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Have you taken the TSI test?
Yes
No If yes, date: ________________________________________
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I am exempt from the TSI, based on:
ACT
SAT
STAAR
Other: ________________________________________________________________
(Proof of TSI exemption must be received prior to registration.)
Desired Academic Program: _______________________________________________
Academic Program Code: ______________________
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Educational objective:
Associate in Applied Science
Associate in Arts/Science
Certificate
Bachelor of Arts
Bachelor of Science
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Master’s Degree
Doctorate
Improve job skills
Marketable skills record
Personal enrichment
Undecided
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Are you receiving veteran’s benefits?
No
Yes If yes, indicate type:
Veteran
Veteran’s dependent
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Are you:
a single parent with custody or joint custody of a child under 18
a homemaker or unemployed
single and pregenant
prefer not to answer
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Do you require special services for:
physical disability
learning disability
prefer not to answer
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Will you also be enrolled in high school during the semester for which you are applying to Navarro College?
Yes
No
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Academic term you plan to begin enrollment:
Fall
Spring
Summer I
Summer II
Enrollment year: ___________________________________________
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Seeking admission as:
Early Admissions for High School students
Dual Credit for High School students
High school graduate
GED Test completed
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College transfer
College graduate
No High School diploma or GED
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During the semester for which you are applying, will you be enrolling only in online courses?
Yes
No
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Are you on suspension from the last school or college you attended?
Academic
Disciplinary
Not applicable
Date of high school graduation or GED completion: Month _________________________________________ Day _____________ Year ____________________________
High school attended ___________________________________________________________ City _________________________________ State ____________
List all colleges or universities in which you have been officially enrolled:
COLLEGE/UNIVERSITY
CITY, STATE
LAST YEAR OF ATTENDANCE
SEMESTER HOURS COMPLETED/DEGREE EARNED
_______________________________________ _______________________ ____________________________ _________________________________________
_______________________________________ _______________________ ____________________________ _________________________________________
_______________________________________ _______________________ ____________________________ _________________________________________
NOTE: An official transcript that includes grades from the last semester in attendance is required from all institutions previously attended.
My signature below indicates that I understand I must meet all admission requirements and that I agree to provide the Office of Admissions and Records with
official transcripts or official GED scores within 12 days following the beginning of a Fall or Spring semester or within 4 days following the beginning of a
summer term. If I do not provide official transcripts or GED test scores within the allotted amount of time following the beginning of a semester, I give Navarro College
permission to request and obtain my official transcripts or GED test scores. I understand that it is my responsibility to ensure that Navarro College receives official
transcripts and GED scores within the time frame described above.
___________________________________________________ ______________________________________________ _____________________________
Signature
Social Security Number
Date
CONTINUE ON BACK ►
12/2014
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