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Northern Essex Community College has an open admission policy and accepts students on a rst-come, rst-served basis for most programs. To be
admitted to a degree or certicate program, you must have earned a high school diploma or GED/HiSet, or other state approved equivalency credential.
Some programs have special admission criteria and/or limited enrollment. Please check the college website at for details on these
special programs.
Please print clearly
Social Security Number: Date of Birth:______/______/______
For oce use only: generated student ID
Required if seeking nancial aid or tax credit
Month Day Year
Full Name: _______________________________________________________________________ Any Previous Last Name(s): ____________________________________
Last First Middle
Preferred First Name:
Mailing Address:
Street Apt.
City State Zip
Email Address: ____________________________________________________ Primary Phone #: ______________________ ALT #:________________________________
I wish to receive non emergency text messages from NECC. (Optional). Cell phone #_________________________________________________________________
[Consent is revoked by notifying Enrollment Services].
Demographic Information - Optional
We ask the following questions to help the College best serve our students and our region. Information provided will not be used in a discriminatory manner.
Your response to these questions makes it possible for us to apply for resources to help support our students.
Race/Ethnicity: Please answer both a. and b.
a. Ethnicity: Are you of Hispanic or Latino origin?
Yes No Gender: Male
Female ______________________________________________________
b. Race: Choose one or more from the list below.
African-American/Black American Indian/ Alaskan Native Cape Verdean Native Hawaiian/Pacic Islander White/Caucasian
c. Did your parent(s) graduate from college with a bachelor’s degree? Mother: Yes No Father: Yes
Citizenship Information
Are you a U.S. Citizen? Yes No
If No, are you a Permanent Resident?
Yes –
Please submit a copy of both sides of your Permanent Resident Card
No – Current Visa Type?: ___________________________ (Please submit a copy) Country of Birth:________________________________________________
Country of Citizenship:________________________________________________ Will you require a student (F-1) visa?
Yes No (If Yes, an I-20 application packet is
available at the Behrakis One-Stop Student Center and the CPAC in Lawrence and must be submitted along with completed documentation at least 6 weeks prior to the date classes begin.)
Please check the in-state or reduced tuition eligibility category that applies to you:
_____ I have been a Massachusetts resident for six (6) continuous months and intend to remain here.
_____ I have been a Massachusetts resident for LESS THAN six (6) continuous months.
Previous State: ___________________________________________________
_____ I am a resident of Maine, New Hampshire, Vermont, Rhode Island, or Connecticut.
As proof of my intent to remain in Massachusetts, I possess at least 2 of the following documents, which I shall present to the institution upon request. These documents*
are dated within one (1) year of the start date of the academic semester for which I seek to enroll (except possibly for my high school diploma). The institution reserves the
right to make any additional inquiries regarding the applicants status and to require submission of any additional documentation it deems necessary.
Please check-o those documents you possess as proof of your intent to remain in Massachusetts.
_____Valid drivers license _____Utility bills* _____Employment pay stub*
_____Valid car registration _____Voter registration* _____State/Federal tax returns*
_____Mass. high school diploma _____Signed lease or rent receipt* _____Military home of record*
_____Record of parents residency for unemancipated person* _____Other
_____I am a member of the armed forces (or spouse or unemancipated child) on active duty in Massachusetts.
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__________________________ _______________________
__ Dates of Attendance: Degree Received:
_____________________________________ Degree Received:______
Veteran’s Services
Active Duty
Active Reserve
Dependent of National Guard or Reserve
Please print clearly
Starting Semester
Choose Only One:
Fall/September: Spring/January:
Year Year
Student Type:
First Time (You never attended college before)
Previous NECC Student (You attempted or received college credit from NECC before)
Transfer Student (You previously attended another college and received college credit)
Summer: ________________________
Educational Objectives
Intend to pursue a degree or certicate program.
Please select at least one major and write exactly as shown on list of majors page.
Fi rst Ch o ice: _____________________________________________________________ S econd C h oice o r Dual Majo r : ______________________________________________________
If you are unsure about your selection and would like further guidance please check here
What is your overall goal at NECC?
Earn a degree or certicate
Transfer to a 4-year institution
If transfer, are you interested in:
Mass Transfer: Transfer to MA public institution with tuition benet
Bachelors Degrees at NECC: NECC graduates can earn a bachelor’s degree on campus through one of our 4 year partnerships.
High School Education
Will you have a high school diploma or your GED/HiSet before you begin classes?
Yes - Year of Graduation ______________ or Year received GED/HiSet:_ No
High School Name: ________________________________________________________________ City: ______________________________State:___________________
Please submit one of the following: your nal high school transcript and/or high school diploma, GED/HiSet diploma and/or scores, or a transcript from an
approved home school program.*
* Diplomas and transcripts from foreign countries must be evaluated for US equivalency by a recognized credential evaluation agency such as
the Center for Educational Documentation (CED),
College Education
If applicable:
1. College Name: _______________________________________________________________City:_________________________________________State:____________
_____________________________________ Graduation Date:______ ______________________________________________
2. College Name: City:_________________________________________State:____________
Dates of Attendance: Graduation Date: ______________________________________________
Veterans and Military Information — please check all that apply
Inactive Reserve National Guard Veteran
Dependent of Active Duty Military Dependent of Veteran
Interests — please check all that apply
Athletics (see below) Clubs & Organizations Commonwealth Honors Program Honors Leadership Opportunities
MASS Transfer/Transfer Options Student Newspaper Study Abroad Theater
Are you interested in playing any of the following sports?
Baseball Basketball Cross Country
Basketball Cross Country
Outdoor Track & Field
Outdoor Track & Field Soccer
_____________________________________________________________ ______________________________________________________________
_ ____________________________________________________________ ______________________________________________________________
_____________________________________________________________ ______________________________________________________________
_ ____________________________________________________________ ______________________________________________________________
FAMILY Educational Rights and Privacy Act (FERPA)
Authorization to Release Information to a Third Party
Student Name: ________________________________________________________________ NECC ID no.:
The Family Educational Rights and Privacy Act (FERPA) prohibits an institution of higher education from releasing most student record information to
any requesting third party, absent the students prior written consent. Failure of the College to comply with FERPA may result in a violation of federal
law and jeopardize the College’s federal funding. I authorize Northern Essex Community College to release my educational record information to:
Name of Individual: Relationship:
I authorize NECC to release the following information (check all that apply):
Student Accounts: Includes tuition and fee balance, nancial holds, mailing and billing address, payment plans, accounting statements, collections
information, and debt information.
Admissions: Includes the date of application, program selected, documents received, documents pending, date of admission, admissions status,
and condition of admission.
Registration: Includes current enrollment, date of enrollment activity, enrollment status, residency status, semesters attended, and mailing address
Academic Records: Includes courses taken, grades received, GPA, academic progress, honors, transfer credit, and degrees earned.
Financial Aid: Includes all general nancial aid information.
CODE WORD: __________________________________ (The code word is used to validate your authorized individuals. Please provide your code word to
the authorized individuals listed above).
Emergency Contact Information (optional)
Name: _______________________________________________________________________________ Relationship: ________________________________________
First Last
Address: ________________________________________________________________________________________________________________________________________________
Street Apt.
City State Zip
Telephone: ______________________________________________________________________________________________
Applicant Signature
I certify that all the information submitted on this application is true.
Signature of Applicant: _________________________________________________________________ Date: ___________________________________________
Signature of Parent: ____________________________________________________________________
Only needed if Applicant is under 18 years of age
Questions? Please call Behrakis One-Stop Enrollment Services: 978-556-3700.
Date: ___________________________________________
Armative Action and Equal Opportunity Policy: Northern Essex Community College is an armative action/equal opportunity college and does not discriminate on
the basis of race, color, national origin, sex, disability, religion, age, veteran status, genetic information, gender identity or sexual orientation in its programs and activities
as required by Title IX of the Educational Amendments of 1972, the Americans with Disabilities Act of 1990, Section 504 of the Rehabilitation Act of 1973, Title VII of the Civil
Rights Act of 1964, and other applicable statutes and college policies. The College prohibits sexual harassment, including sexual violence. Inquiries or complaints concerning
discrimination, harassment, retaliation or sexual violence shall be referred to the College’s Armative Action and/or Title IX Coordinator, the Massachusetts Commission
Against Discrimination, the Equal Employment Opportunities Commission or the United States Department of Education’s Oce for Civil Rights.
All inquiries concerning application of the above should be directed to the College’s Armative Action/Section 504 Compliance Ocer: Elizabete Trelegan, Human
Resources, Section 504/ADA Compliance; Title IX; Armative Action; Northern Essex Community College, 100 Elliott Street, B-219, Haverhill, MA 01830; Phone: 978-556-3928;
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PLEASE NOTE: The following Majors are subject to change. Please see for current information.
American Sign Language
Associate Degree
American Sign Language Studies * DF
(American Sign Language Studies Concentration)
(Human Services Concentration)
(Interpreting Transfer Concentration)
Sign Language Interpreting Certicate *DF
Art & Design
Associate Degree
General Studies: Art and Design
Associate Degrees
Business Management
Business Management: Healthcare Practice
Business Transfer
Hospitality Management
Communication Arts
Associate Degrees
General Studies: Music Option
Liberal Arts: Journalism/Communication Option
Music Technology Certicate
Computer & Information Sciences
Associate Degrees
Computer & Information Sciences: Computer Science
(Transfer Concentration)
(Web Development Concentration)
Computer & Information Sciences: Information Technology Option
Computer & Information Sciences: Networking and Security Option
Technology & Business
Computer Networking Certicate
Criminal Justice
Associate Degree
Criminal Justice
Criminal Justice Private & Public Safety (accelerated)
Law Enforcement Certicate
Associate Degrees
Early Childhood Education
Educational Studies
(Middle/High School Teaching Concentration)
(Elementary Teaching Concentration)
Early Childhood Director
General Studies
Associate Degrees
General Studies: Art and Design
General Studies: Individualized Option
General Studies: Music Option
Associate Degrees
Business Management: Healthcare Practice
Exercise Science
(Exercise Science Transfer Concentration)
(Health Fitness Concentration)
General Studies: Health Specialization
Nursing (ADN)* DF
anced Placement Option - LPN Bridge)* D
Paramedic Technology* DF
Public Health*
Radiologic Technology* DF
Respiratory Care* DF
Community Health Worker Certicate
Dental Assisting Certicate* DF
Healthcare Technician Certicate
Medical Assistant Certicate: Day Option* DF
Medical Assistant Certicate: Evening Option*
Medical Billing Certicate
Medical Coding Certicate
Medical Oce Assistant Certicate
Paramedic Technology Certicate* DF
Practical Nursing (PN) Certicate* DF
Sleep Technologist Certicate*
Human Services
Associate Degree
Human Services* D
Alcohol/Drug Abuse Counseling Certicate* D
Community Support Human Services Practitioner Certicate* D
t Support Certicate* D
Liberal Arts
Associate Degrees
Liberal Arts
Liberal Arts: Journalism/Communication Option
Liberal Arts: Philosophy Option
Liberal Arts: Psychology Option
Liberal Arts: Writing Option
Associate Degrees
Chemistry/Physics/Environmental Science
Laboratory Science
(Analytical Chemistry Concentration)
(Biotechnology Concentration)
(Environmental Sciences Concentration)
(Forensic Science Concentration)
Technology & Engineering
Associate Degrees
Engineering Science
(Chemical Engineering Concentration)
(Civil/Environmental Engineering Concentration)
(Electrical/Computer Engineering Concentration)
(Mechanical Engineering Concentration)
(Plastics Engineering Concentration)
Engineering Science Advanced Manufacturing
(Electronics Concentration)
(Precision Machining Concentration)
Engineering Science Technology Option
(Electronic Technology Concentration)
(Mechanical Technology Concentration)
Advanced Manufacturing Precision Machining Certicate
Computer Aided Drafting Certicate
Electronic Equipment Technology Certicate
The Exploratory Program is for students new to NECC with no accumulated
college-level credits or who have not decided on a major.
D = Day Acceptance Only E = Evening Acceptance Only F = Fall Semester Acceptance Only
* Criteria-Based programs have special admission requirements and/or limited enrollment.