ENROLLMENT INFORMATION
 
Term & Major
  

PERSONAL INFORMATION
 
Student Name
Legal Name
 
 
 
 
Other Name Used
Name on previous academic records (if different from legal name):

Social Security Number
 
###-##-####
 
###-##-####

Date of Birth
 
yyyy

Gender

This information will be used for state and federal reporting purposes. It is optional and voluntary and will not be used for a discriminatory purpose.

 

Ethnicity and Race

Per U.S. Dept. of Education guidelines, colleges are required to collect the following racial and ethnic data.

 
Hispanic - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.


If yes, check one or more:

 

What is your race? Check one or more:
 
Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent.
A person having origins in any of the black racial groups of Africa.
A person having origins in any of the original peoples of North and South America (including Central America) who maintains cultural identification through tribal affiliation or community attachment.
Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
CONTACT INFORMATION
 
Current Mailing Address
 (please include apartment/suite numbers)
OR
OR

Permanent Address
 
   (please include apartment/suite numbers)
 
  OR
  OR

Additional Contact Information
   
    (###) ###-####
    ####
 
An email address is required for important messages about your admission and registration. Please enter an email address that you check regularly.