Fillable APPLICATION FOR ADMISSION TO COMMUNITY EDUCATION GENDER: Male (Allan Hancock College)

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APPLICATION FOR ADMISSION TO COMMUNITY EDUCATION GENDER: Male (Allan Hancock College)

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The APPLICATION FOR ADMISSION TO COMMUNITY EDUCATION GENDER: Male (Allan Hancock College) form is 2 pages long and contains:

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  • 23 check-boxes
  • 68 other fields

Country of origin: US
File type: PDF

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H___________________________ Semester and Year________________
Submit completed application to Community Education, Building S, Santa Maria Campus, 800 S. College Drive, Santa Maria CA 93454
1
APPLICATION FOR ADMISSION TO COMMUNITY EDUCATION
Application for new students. Answer all questions, printing legibly and using blue or black ink.
LAST NAME ______________________________ FIRST NAME__________________________ MIDDLE INITIAL________
OTHER NAMES USED: ___________________________________________
DATE OF BIRTH: --
M M D D Y Y Y Y
GENDER: £ Male £Female £Decline to State
CURRENT MAILING ADDRESS: _____________________________________ _____________________ _____ _________
Number and street, and unit number if applicable City State Zip
PHONE NUMBER: (_______)______-_____________ Home £ Cell £ ALTERNATE: (______)______-_______________
PERSONAL EMAIL ADDRESS: __________________________________________________________
HAVE YOU
ATTENDED HANCOCK COURSES BEFORE? YES NO PROPOSED MAJOR: CE Noncredit Coursework
EDUCATION GOAL: I AM ATTENDING COMMUNITY EDUCATION TO: (Select one from the drop-down menu)
Per US Dept. of Education guidelines, colleges are required to collect the following racial and ethnic data. WHAT IS YOUR
RACE / ETHNICITY? (Select one from the drop-down menu):
MY CITIZENSHIP STATUS IS (Select one from the drop-down menu):
£ No documents
EDUCATION LEVEL - THE HIGHEST LEVEL OF EDUCATION I HAVE COMPLETED IS:
£
Not a high school graduate and not currently enrolled
in high school.
£ Student currently enrolled in high school.
£ Earned a U.S. High School diploma in (Year): ______
£ Passed the U.S. GED or High School Equivalency in
(Year): ______
£ Foreign Secondary School Diploma/ Certificate of
Graduation (HS or University) - (Year): ______
£ Received an Associate’s Degree (U.S.) in (Year):
______
£ Bachelor’s Degree or higher in (Year): _______
CALIFORNIA RESIDENCY:
Have you lived in California continuously for the past two years?
YES NO
If you haven’t lived in California for the past two years, when did
your present stay in California begin?
--
M M D D Y Y Y Y
STUDENT’S MILITARY SERVICE STATUS (CHECK ONE):
____ I am not a member of the U.S. military
____ I am currently serving on Active Duty
____ I am a Veteran
(E) Earn a vocational certificate w/out transfer
Asian
U.S. Citizen
H___________________________________ Semester and Year_____________
Submit completed application to Community Education, Building S, Santa Maria Campus, 800 S. College Drive, Santa Maria CA 93454
2
APPLICATION FOR ADMISSION TO COMMUNITY EDUCATION
CONTINUED
Application for new students. Answer all questions, printing legibly and using blue or black ink
.
LAST NAME ______________________________ FIRST NAME__________________________ MIDDLE INITIAL________
COMMUNITY EDUCATION REGISTRATION - FOR NONCREDIT COURSES ONLY
COURSE RECORD NUMBER (CRN)
DAYS & TIMES
FEE (IF ANY)
M
ETHOD OF PAYMENT:
CHECK (Do not mail cash). CREDIT CARD Select one: Visa MasterCard Discover American Express
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Credit Card #____________________________________________
Exp. Date_____________
Security Code
___________
Print Name _________________________________________
Authorizing Signature
_________________________________________
Credit Card Address (number only( and
Zip Code: _________________________________________________________________________________________________
TOTAL FEES
(if any)
$
Nondiscrimination Statement: The Allan Hancock Joint Community College District (“District”) is committed to equal opportunity in employment and all access to
institutional programs and activities. The District, and each individual who represents the District, shall provide access to its employment opportunities, services, and
classes, and programs without regard to national origin, religion, age, sex or gender, gender identity, gender expression, race, color, medical condition,
genetic information, ancestry, sexual orientation, marital status, physical or mental disability, or military and veteran status of any person, or because he or
she
is perceived to have one or more of the foregoing characteristics, or based on association with a person or group with one or more of these actual or
perceived characteristics.
Before submitting the application, VERIFY that the information you have provided is complete and correct. NO CHANGES may be made once the application is submitted.
THE STUDENT’S SIGNATURE IS MANDATORY. BY SIGNING, I DECLARE THAT: All of the information in this application pertains to me. Under the penalty of perjury,
the statements and information submitted in this admissions application are true and correct. I understand that falsification, withholding pertinent data, or failure
to report changes in residency may result in District action.
Student’s Signature (mandatory) Date
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APPLICATION FOR ADMISSION TO COMMUNITY EDUCATION GENDER: Male (Allan Hancock College)

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Completed 2 February 2021

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