APPLICATION FOR ADMISSION
FOR OFFICE USE ONLY
IS OS _____________________________
Sta Initial _________________________
In accordance with §23.2.2:1 of the Code of Virginia, your name, date of birth, gender, and student identication number will be submitted to the
Virginia State Police. By proceeding with the application process, you consent to this submission.
Please note: It will be necessary for applicants who wish to be considered for veterans’ benets, nancial aid, and Hope Scholarship/Lifetime Learning
tax credit to provide a Social Security number to the college. To protect your privacy, your Social Security number will not be used as your student
identification number. The VCCS will only use your Social Security number in accordance with federal and state reporting requirements, and for
identication purposes within the VCCS. It shall not permit further disclosure unless required or authorized by the Family Educational Rights and Privacy
Act of 1974, 20 U.S. C. Code 1232g, or pursuant to your obtained consent.
Possessing, brandishing, or using a weapon while on any college or VCCS oce property, within any college or VCCS oce fa cilities, or while attending
any college or VCCS educational or athletic activities by students is prohibited, except where possession is a result of participation in an organized and
scheduled instructional exercise for a course, when secured inside a vehicle, or where the student is a law enforcement professional. By proceeding with
the application process, you acknowledge and agree to abide by this policy if accepted to a VCCS college.
If you have ever been in foster care, please contact the G
reat Expectations program at 804 -819- 4690 after completing this application .
Social Security Number: _____________ - ____________ - _____________
(Note: Providing this data will enable you to look up and reset a password for your username.)
Former name (if applicable):
Date of birth: _______________ Month _______________ Day _______________ Year
Which college/campus do you plan to attend? _______________________________ College _
In what type of class(es) will you be enrolling? Credit class(es) Non-credit class(es)
What term do you plan to begin classes? 20___ Term: Fall (Aug -Dec) Spring (Jan -May) Summer (May -Aug)
Have you previously attended, applied for admission to, or been employed by any Virginia community college?
No Yes - Enter Student ID (Empl ID) number if known: ______________
Primary Phone Number (include area code): ( ________
10. Mailing address: _________________________________________________________________________________
Country, if not USA
11. City/County/or non -VA State of Residence: ____________________________
(Provide what you consider to be your location of residence. If you temporarily relocated to your current address to get
an education, you should provide your previous location.)
125-030 Rev 6/14
Thank you for your interest in applying to NOVA. To apply for admission, you need to complete a brief application and provide basic information about
yourself including contact information, education history and details about your residency.