School of Extended Learning
NONCREDIT APPLICATION FOR ADMISSION
(Tuition-free courses only)
Term Applying For:
□ Summer □ Fall □ Spring
Year______
Full Legal Name:
LAST:_____________________________________________________
FIRST:____________________________________________________
MIDDLE:__________________________________________________
Previous Name on Academic Records:
LAST:__________________FIRST______________MIDDLE__________
Email: ___________________________________________________
Date of Birth: ______/______/_______ Age:________
(Minor Enrollment form required if under 18 years of age)
Gender: □ Male □ Female □ Decline to state
Current Mailing Address:
_________________________________________________________
Number & Street Apt.
_________________________________________________________
City State Zip
Country, if other than U.S. ___________________________________
Telephone Number ( )___________________________________
Educational Level:
(As of the start of application term, you are or will be)
□ (0) Not a graduate of, and no longer enrolled in high school
□ (1) Currently enrolled in K-12 (high school)
□ (2) Enrolled in Adult High School
□ (3) Received high school diploma from U.S. school
□ (4) Passed the GED/received a High School Certificate of Equivalency
□ (5) Received a Certificate of California High School Proficiency
□ (6) Received diploma of graduation from a foreign Secondary School
□ (7) Associate Degree
□ (8) Bachelor Degree or higher
Race/Ethnicity :
Are you of Hispanic or Latino ethnicity? □ Yes □ No (check one or more)
□ 01- Hispanic, Latino
□ 02- Mexican, Mexican-
American, Chicano
□ 03- Central American
□ 04- South American
□ 05- Hispanic Other
□ 06- Asian Indian
□ 07- Asian Chinese
□ 08- Asian Japanese
□ 09- Asian Korean
□ 10- Asian Laotian
□ 11- Asian Cambodian
□ 12- Asian Vietnamese
□ 13- Filipino
□ 14- Asian Other
□ 15- Black or African American
□ 16- American Indian/Alaskan
Native
□ 17- Pacific Islander Guamanian
□ 18- Pacific Islander Hawaiian
□ 19- Pacific Islander Samoan
□ 20- Pacific Islander Other
□ 21- White
Education Goal:
□ (A) Obtain an Associate Degree and transfer to a 4-year
institution
□ (B) Transfer to a 4-year institution without an Associate Degree
□ (C) Obtain a 2-year Associate Degree without transfer
□ (E) Earn a vocational certificate without transfer
□ (F) Discover / formulate career interests, plans, goals
□ (G) Prepare for a new career (acquire job skills)
□ (H) Advance in current job / career (update job skills)
□ (I) Maintain certificate or license
□ (J) Educational Development (intellectual, cultural, physical)
□ (K) Improve basic skills (English, reading or math)
□ (L) Complete credits for high school diploma or GED
□ (M) Undecided on goal at this time
□ (N) To move from noncredit coursework to credit coursework
□ (O) 4-year college student taking courses to meet 4-year
college requirements
Parents / Guardian Education Level:
(Regardless of your age, please indicate the education levels of
the parents and/or guardians who raised you)
Parent / Guardian #1
□ (1) Grade 9 or less
□ (2) Some high school; did
not graduate
□ (3) High School graduate
□ (4) Some college; no
degree
□ (5) Associate’s Degree
□ (6) Bachelor’s Degree
□ (7) Graduate or
professional degree
beyond BA/BS
□ (X) Unknown
□ (Y) No parent or guardian
Parent / Guardian #2
□ (1) Grade 9 or less
□ (2) Some high school; did
not graduate
□ (3) High School graduate
□ (4) Some college; no
degree
□ (5) Associate’s Degree
□ (6) Bachelor’s Degree
□ (7) Graduate or
professional degree
beyond BA/BS
□ (X) Unknown
□ (Y) No parent or guardian
To be signed by all students
I declare under penalty of perjury that the statements submitted by me
are true and correct. All materials submitted by me for the purposes of
admission become the property of Santa Barbara City College. I
understand that falsification, withholding pertinent data, or failure to
report change in residence may result in my dismissal.
Student Signature: __________________________Date________
OR
Power of Attorney/ Trustee
Signature__________________________________
