Fillable APP ANTELOPEVALLEYCOLLEGE Final %282%29 (Antelope Valley College)

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APP ANTELOPEVALLEYCOLLEGE Final %282%29 (Antelope Valley College)

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Applicaon Year: _______________ Semester (s): ⃝ Fall (Aug –Dec) ⃝ Summer (Jun –Aug) ⃝ Spring (Feb – Jun) ⃝ Intersession (Jan – Feb)
Last Name: ____________________________________ First Name: __________________________________ Middle: __________________
Previous Names Used: ______________________________________________________________________________________ _____________
Social Security Number: __________-_______-____________ Date of Birth: ______/______/_________ Gender: ⃝ Male ⃝ Female
Mailing Address: Street: ______________________________________ City: ______________________ State: __________ ZIP:____________
Permanent Address (if dierent from Mailing Address OR if Mailing Address is a PO BOX):
Street: ______________________________________ ______________ City: ______________________ State: __________ ZIP:____________
Home Telephone Number: (______) _______ _______________ Alternave Number: (______) __________ ______________
3041 West Avenue K, Lancaster CA 661.722.6504 www.avc.edu page 1
Cizenship (Select One):
⃝ US Cizen (1) Non-US Cizen: ⃝ Permanent Resident (2) ⃝ Student Visa (5) Visa Type: ________________________
⃝ Temporary Resident/Amnesty (3) ⃝ Other Status (6) Type: ____________________________
⃝ Refugee/Asylee (4)
Race / Ethnicity:
Are you Hispanic / Lano: ⃝ Yes (1) ⃝ No
⃝ Mexican, Mexican-American, Chicano (2) ⃝ Central American (3) ⃝ South American (4) ⃝ Hispanic: Other (5)
⃝ Asian: Indian (6) ⃝ Asian: Chinese (7) ⃝ Asian: Japanese (8) ⃝ Asian: Korean(9)
⃝ Asian: Laoan (10) ⃝ Asian: Cambodian (11) ⃝ Asian: Vietnamese (12) ⃝ Asian: Filipino (13)
⃝ Asian: Other (14) ⃝ Black or African American (15) ⃝ American Indian/Alaskan Nave (16)
⃝ Pacic Islander: Guamanian (17) ⃝ Pacic Islander: Hawaiian (18) ⃝ Pacic Islander: Samoan (19)
⃝ Pacic Islander: Other (20) ⃝ White (21)
FERPA Nocaon: Under nocaon of the Family Educaon Rights & Privacy Act, you may at the me you apply, direct the College to with-
hold Release of Directory Informaon to persons or agencies not covered by your name, address, phone number, dates of aendance, major
eld of study, awards/degrees received, date of birth and most recent instuon previously aended. Do you wish AVC to withhold your Di-
rectory Informaon? ⃝ Yes ⃝ No
Student Type/Enrollment Status: (Select one)
⃝ First me college student (1) ⃝ First me AVC (transfer from another college) (2)
⃝ Returning to AVC (3) ⃝ Concurrent Enrollment/Special Admit/K-12 grade (Y)
Intended Major or Program of Study:
______________________________________ (Please see the list of degrees and cercates oered by AVC at the end of the applicaon)
Residency:
Have you lived in California for at least the last 2 years? ⃝ Yes ⃝ No If no, when did your CURRENT stay in California begin? ____________
Do you intend to maintain California as your state of legal residence? ⃝ Yes ⃝ No
List places (states or countries) and dates you have lived in the last two years before your present stay in California began:
State/Country: __________________From: _______To________ State/Country: ______________________From: ________To: ________
State/Country: __________________From: _______To________ State/Country: ______________________From: ________To: ________
VET
Residency Connued:
At any me during the past two years have you (if you are under 19 years of age, answer for your parents):
Declared Residency in another state for income tax purposes? ⃝ No ⃝ Yes If Yes, in what year? ______________
Registered to vote in another state? ⃝ No ⃝ Yes If Yes, in what year? ______________
Declared residency at an out-of-state college or university? ⃝ No ⃝ Yes If Yes, in what year? ______________
Peoned for a Lawsuit or a Divorce as a resident of another State? ⃝ No ⃝ Yes If Yes, in what year? ______________
⃝ None apply to me
Special Residency Categories:
⃝ Full-me employee, or spouse or dependent of a full-me employee of any of the following colleges / universies: California
Community College, California State University or College, University of California, Marime Academy
⃝ Full me credenaled employee of a California public School enrolled in college to full credenal related requirements
⃝ Seasonal agricultural worker for two month of each of the past two years
⃝ Foster Youth (Your response will help the college provide addional resources and will not aect your admission to college):
⃝ Currently a Foster Youth ⃝ Previous Foster Youth (aged out or emancipated
⃝ Out of State Foster Youth ⃝ Previous Out of State Foster Youth (aged out or emancipated)
⃝ Previous Foster Youth (Did not age out or emancipate from the system)
⃝ None apply to me
Military Status (Please select one):
⃝ Acve military: State of Legal Residence (Military): ________ State (Home of Record): ________ Staoned in CA: ⃝ Yes ⃝ No
⃝ Veteran (acve or reserve) discharged within the last year: Date of Separaon: ____________ State (Home of Record):__________
⃝ Veteran (acve or reserve discharged over a year ago: Date of Separaon: ________________ State (Home of Record): _________
⃝ Dependent, Spouse or child of acve military:
Military Member’s State of Legal Residence (Military): ________ State (Home of Record): ________ Staoned in CA: ⃝ Yes ⃝ No
⃝ Currently in Reserves or Naonal Guard (non-acve) State of Legal Residence (Military): __________ State (Home of Record): _______
Staoned in CA: ⃝ Yes ⃝ No
⃝ None apply to me
3041 West Avenue K, Lancaster CA 661.722.6504 www.avc.edu page 2
Educaonal Status/Educaonal Level:
⃝ H.S. Diploma, or will receive before term begins (3XX) ⃝ Received a cercate of California High School Prociency (5XX)
⃝ Not a graduate of, and no longer enrolled in H.S. (000) ⃝ Received a foreign secondary school diploma 6XX)
⃝ Will be enrolled in college and H.S. at the same me (100) ⃝ Received an Associate degree (7XX)
⃝ Currently enrolled in adult school (200) ⃝ Received a Bachelor’s degree or higher (8XX)
⃝ Passed GED, or received a H.S. cercate of equivalency (4XX)
Educaonal Goal (Choose one):
⃝ Obtain an associate degree and transfer to a 4 year college (A) ⃝ Maintain Cercate or License (I)
⃝ Transfer to a 4 year college without an associate degree (B) ⃝ Educaonal development (J)
⃝ Obtain a 2 year associates degree without transfer (C) ⃝ Improve basic skills in English, reading or math (K)
⃝ Earn a technical cercate without transfer (E) ⃝ Complete credits for high school diploma or GED (L)
⃝ Discover / Formulate career interests, plans, goals (F) ⃝ Undecided on Goal (M)
⃝ Prepare for a new career (acquire job skills) (G) ⃝ Move from noncredit coursework to credit coursework (N)
⃝ 4 year college student taking 4 year college requirements (O)
Are you comfortable reading and wring English? ⃝ Yes ⃝ No
Educaon—Colleges/Universies:
Most Recent College/University Aended:
College/ University Name: _________________________________________ City: _____________________________ State: ________________
Years Aended From______________ To______________ Did you receive a degree? ⃝ No ⃝ Yes If Yes: Year of Degree: _____________
Addional Colleges/Universies Aended:
College/ University Name: _________________________________________ City: _____________________________ State: ________________
Years Aended From______________ To______________ Did you receive a degree? ⃝ No ⃝ Yes If Yes: Year of Degree: _____________
College/ University Name: _________________________________________ City: _____________________________ State: ________________
Years Aended From______________ To______________ Did you receive a degree? ⃝ No ⃝ Yes If Yes: Year of Degree: _____________
3041 West Avenue K, Lancaster CA 661.722.6504 www.avc.edu page 3
By Signing below, I cerfy that:
All of the informaon in this applicaon pertains to me.
Under penalty of perjury, the statements and informaon submied in this applicaon are true and correct.
I understand that falsicaon, withholding pernent data, or failure to report changes in residency may result in District acon.
I understand that all materials and informaon submied by me for the purposes of admission become the property of AVC.
Student Signature: ______________________________________________________________ Date: __________________________________
Oce Use ONLY:
⃝ California Resident (5) ⃝ Non-Resident: Out of State (6) ⃝ Non-Resident: Out of Country (8) ⃝ Exempt/Non Resident Tuion (9)
Processed By:_________________________________________________________________ Date:_________________________________
Educaon—High School:
High School Name: __________________________________________ City: __________________________________ State: ________________
Years Aended From___________ To___________ Did you Graduate? ⃝ No ⃝ Yes If Yes: Year of High School Graduaon: ___________
Needs and Interests:
⃝ Basic Skills (PCBS) ⃝ Transfer Info (TFR) ⃝ CalWORKS (CALW) ⃝ Online Classes (ONCL) ⃝ Athletic Interest (ATH)
⃝ Financial Aid (FIN) ⃝ Health Serv (HLTH) ⃝ Tutoring Serv (TUT) ⃝ Career Planning (CAPL) ⃝ Reentry Program (REEN)
⃝ EOPS (EOP) ⃝ Veteran Serv (VSRV) ⃝ Student Government (SG) ⃝ English as a Second Lang (ESL)
⃝ Housing Information (HOUS) ⃝ Employment Assistance (EMP) ⃝ Scholarship Information (SCHL)
⃝ Disabled Student Programs (DSP) ⃝ Academic Counseling/Advising (ACAD) ⃝ Testing, Assessment, Orientation (TAOR)
Employment Expectaon:
⃝ (A) 1-9 hours ⃝ (B) 10-19 hours ⃝ (C) 20-29 hours ⃝ (D) 30-39 hours ⃝ (E) 40 or more hours ⃝ (N) None
3041 West Avenue K, Lancaster CA 661.722.6504 www.avc.edu page 4
Major Codes
Associate in Arts Degrees
Major Description
ADMJ Administration of Justice
CAN Computer Animation
CFE Child and Family Education
CGDP Digital Printing
CT Clothing and Textiles
DPI Digital Photographic Imaging
DSA Deaf Studies: ASL
DSI Deaf Studies: Interpreter Training
ENGT English: Transfer
ENGN English: Non-Tranfer
FCE FCE: Child & Family Development
FCEE FCE: Consumer Education
FCEI FCE: Interior Design
FCEN FCE: Nutrition & Foods
FCET FCE: Clothing & Textiles
GD Graphic Design
ID Interior Design
IMW Interactive Media-Web Design
INA Instructional Aide
KIN Kinesiology
LAMS LAS: Math & Sciences
LASB LAS: Social & Behavioral Sciences
LAAH LAS: Arts & Humanities
MUS Music
PHTC Photography-Commercial
SAG School-Aged Child Care
VDP Video Design & Production
0000 Undeclared *
Associate in Science Degrees
AAA Aeronautical & Aviation / Aircraft
Airframe
AAP Aeronautical & Aviation/Aircraft
Powerplant
AAT Aeronautical & Aviation/Gen. Aircraft
Maint.
ABD Auto Collision Repair Specialist
ABDC Auto Collision Repair & Refinishing
Specialist
ABDR Auto Refinishing Specialist
ACR Air Conditioning Specialist
ACRC Air Conditioning & Refrigeration
Specialist
ACRR Refrigeration Specialist
AFAB Aircraft Fabrication & Assembly
ADA Administrative Assistant
APL Environmental Horticulture
APLC Landscape Construction
AUT Auto/Engine & Drive Trains.
AUTD Auto/Driveability, Emiss., Elect.
BIOL Biological Sciences
BOK Professional Bookkeeping
BUS Business - General
BUSA Business Administration
CA Computer Applications
CIS Business Computer Information
Science
CN Computer Networking Multi-Platform
CSD Computer Software Developer
DRF Drafting/Computer Aided Design
ELE Electrical Technology
ELT Electronics Technology
ENR Engineering
ENT Engineering Technology
FT Fire Technology
MA Medical Office Assistant
MAA Administrative Medical Assistant
MAC Clinical Medical Assistant
MAR Marketing
MATH Mathematics
MGT Management
OFS Office Specialist
PSC Physical Sciences
RADT Radiologic Technology
RE Real Estate
RN Registered Nursing
RSPT Respiratory Therapy
SBM Small Business Management
WFT Wildland Fire Technology
WLD Welding
0000 Undeclared *
Associate in Arts for Transfer Degrees
AAHT Art History for Transfer
ANTT Anthropology for Transfer
ASAT Studio Arts for Transfer
COMT Communication Studies for Transfer
ET English for Transfer
GEOT Geography for Transfer
HT History for Transfer
KINT Kinesiology for Transfer
MUST Music for Transfer
PHIT Philosophy for Transfer
POST Political Science for Transfer
PSYT Psychology for Transfer
SOCT Sociology for Transfer
Associate in Science for Transfer Degrees
ADJT Administration of Justice for
Transfer
BUST Business Administration for Transfer
ECET Early Childhood Education for
Transfer
GET Geology for Transfer
MATT Mathematics for Transfer
PHYT Physics for Transfer
Certificates (CL)
AAT2 General Aircraft Maintenance
ACR1 Air Conditioning Specialist
ACR2 Refrigeration Specialist
AFA1 Aircraft Fabrication & Assembly
AUT1 Driveability, Emiss. & Elec.
AUT2 Engine and Drive Train
BOK1 Professional Bookkeeping Cert.
CNC1 Computer Networking Core
CSU1 CSU General Education Cert*
CT1 Clothing and Textiles
DRF1 Drafting/Computer Aided Design
ELE1 Electrical Technology
FFA1 Firefighter 1 Academy
FT1 Fire Technology
INA1 Instructional Aide
MAC1 Clinical Medical Assistant
MUS3 Music-Commercial : General
OFS1 Office Specialist
RE3 Real Estate Salesperson
UC1 IGETC General Education Cert*
WLD1 Welding
Certificates (CT)
AAT1 Aircraft Airframe
AAT3 Aircraft Powerplant
ABD1 Auto Collision Repair Specialist
ABD2 Auto Refinishing Specialist
ABD3 Auto Coll. & Refin. Spec.
ACR3 Air Cond. & Refrig. Spec.
ADA1 Administrative Assistant
APL1 Environmental Horticulture
APL2 Landscape Construction
BUS1 Business - General
CA1 Computer Applications
CAN1 Computer Animation
CDP1 Digital Printing
CFE1 Child & Family Education
CIS1 Business Computer Info. Science
CNM1 Computer Networking Multi-Platform
CSD1 Computer Software Developer
DPI1 Digital Photographic Imaging
DSA1 Deaf Studies: ASL
DSI1 Deaf Studies: Interpreter Training
ELT1 Electronics Technology
ENT1 Engineering Technology
GD1 Graphic Design
ID1 Interior Design
IMW1 Interactive Media-Web Design
LVN Vocational Nursing
MA1 Medical Office Assistant
MAA1 Administrative Medical Assistant
MAR1 Marketing
MGT4 Management
MUS2 Music-Commercial : Performance
Specialty
PHO1 Photography-Commercial
RE1 Real Estate Broker
SAG1 School-Aged Child Care
SBM1 Small Business Management
VDP1 Video Design & Production
0000 Undeclared *
Local Certificates
GISX Geographic Info Systems LCert*
GRMX Grounds Maintenance LCert*
OSX Office Support Award LCert*
WFTX Wildland Fire Technology LCert*
* Not a Financial Aid Eligible Major. Please do
not select the majors marked with an *
(asterisk), bold, and italicized font if you are a
Financial Aid Student or if you plan to apply
for Financial Aid.
Major Codes
Rev. 12/03/2014
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APP ANTELOPEVALLEYCOLLEGE Final %282%29 (Antelope Valley College)

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Completed 25 July 2020

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