Applicaon for Admission
STUDENT INFORMATION
Social Security Number: Date of Birth:
Name (same as SS card):
Other Name/Previous Name:
Mailing Address:
City, State, Zip:
Home Phone: Cell Phone:
Email:
Employment plans while enrolled: Full Time Part Time Not employed
Did either of your parents complete a 4-year degree?
Yes No
Which are you?
Current High School student First me to enter college Transferring from another college Returning to ANC (MCCC)
P.O. Box 1109
Blytheville, AR 72316
Pho
ne (870) 838-2955
Fax (870) 763-1654
Email: admissions@smail.anc.edu
www.anc.edu
RESIDENCY INFORMATION
Are you a legal resident of Mississippi County, AR, living in-county at least 6 months prior to this applicaon?
Yes No
If NO, please list county and state:
GENDER/ETHNICITY INFORMATION
Check all that apply:
Male Female
America Indian/Alaskan Nave Asian Black/African American Hispanic/Lano Nave Hawaiian/Pacic Islander White
Other:
(Voluntary informaon to be used in a non-discriminatory manner with applicaon civil rights laws for reporng and stascal purposes only and cannot aect your admission eligibility.)
CITIZENSHIP
What is your cizenship?
U.S. Cizen
Non-Resident Alien: Country Visa Type: Expiraon Date:
Resident Alien (Immigrant) Country: Card # Date Issued:
PRIOR EDUCATION/TRANSFER INFORMATION
High School Graduate On-line High School Graduate GED Homeschool Graduate Did not graduate
Name of High School/GED Program: City, State Grad. Year
Previous colleges aended:
VETERAN AFFAIRS
I am (a)
Veteran Veterans Spouse Veterans Dependent Not requesng Veterans Benets Not a Veteran
EDUCATIONAL GOALS (*1,3,4 require selecon on back of this applicaon)
(1) Earn 2 year degree for transfer to another college
(
2) Take courses to transfer to another college, but not earn a degree
(3) Earn a 2 year Associate in Applied Science degree (non-transfer)
(4) Earn a Technical Cercate or Cercate of Prociency (non-transfer)
(5) Take career/job related courses but not graduate (Soluons Group)
(6) Take course(s) for personal interest, but not graduate or earn degree
(7) Improve basic learning skills, but not graduate or earn degree
(8) Other or undecided
SELECTIVE SERVICE STATUS
In compliance with Act 228 of 1997
Female
Current member of armed forces/acve duty
Under 18 years of age as of applicaon date
Over 25 years of age as of applicaon date
Exempted resident alien (must comply with cizenship queson)
Registered with Selecve Service
Other
EMERGENCY CONTACT INFORMATION
Nam
e: Phone: Relaonship to student:
I cerfy that the informaon included on this applicaon is accurate. I understand that giving false informaon or withholding informaon may
make me ineligible for admission or connuaon at Arkansas Northeastern College.
Signature: Date:
Oce Use Only: Student ID # Notes: Rev.07.02.19
Semester you plan to aend:
Fall Spring
Summer I Summer II
click to sign
signature
click to edit
DEGREE/CERTIFICATE PROGRAMS
If you checked 1, 3, or 4 on the Education Goals section of the application, please mark accordingly.
Associate Transfer Degrees (In-Class/Hybrid) (*1)
Associate of Arts
Select a Concentration:
AA Art/Music
AM Math/Science
AE English/History/Speech
AP Psychology/Sociology/Law
AH Allied Health
AU – Undecided
A
ssociate of Science
AF Business
AJ Criminology
CE Childhood Education (Mid-level 4-8)
Select a Concentration for CE Major:
K-6
Math/Science
Art/Math
Math/Social Studies
Art/Science
Science/Social Studies
Art/Social Studies
A
ssociate of General Studies
Select a Concentration:
GP Pre-Allied Health
GM – Mathematics/Sciences
GAFine Arts/Perf. Arts
GC – Computer Technologies
GH – Humanities/Social Sci.
GK – Music
Associate Transfer Degrees (Online) (*1)
IA – Associate of Arts
I
B Associate of Science Business
IC Associate of Science Criminology
IE Associate of Science Childhood Education
Select a Concentration for IE major:
K-6
Math/Science
Art/Math
Math/Social Studies
Art/Science
Science/Social Studies
Art/Social Studies
Online Associate of Applied Science Degrees (*3)
IJ Criminal Justice
IS Steel Industry Technology
Associate of Applied Science (*3)
14 Advanced Manufacturing Technology
22 – Air Conditioning & Refrigeration
04 Aviation Maintenance
05 Computer Information Systems
17 Criminal Justice
20 Early Childhood Education
26 Nursing (RN)
10Office Management
13
Steel Industry Technology
24 – Welding
Technical Certificate (*4)
57 Administrative Support
52 Air Conditioning & Refrigeration
51 Aviation Maintenance
61 Dental Assisting
62 Paramedic
60 Practical Nursing (LPN)
55 – Welding
Certificate (*4)
65General Studies
Certificate of Proficiency (*4)
72 Advanced Manufacturing
75 Air Conditioning & Refrigeration
91 Child Development Associate (CDA)
70 Clerical Support
81 Construction Technology
83Criminal Justice
94 Emergency Medical Technician (EMT)
74 General Aviation
69 General Industrial Technology
76 Industrial Electrical Systems
95 Nursing Assistant (CNA)
99 Phlebotomy
79 Welding
To complete your application, please submit the following:
Official high school transcript or GED Test Scores (if you have never attended another college/university)
Official college transcript(s) for all other colleges/universities you have attended
Placement test scores—ACT or ACCUPLACER
Immunization Records—students must have 2 doses of the MMR vaccine (excludes ONLINE ONLY degrees/certificates)
Fo
r Disability Services, contact Blythe Gillen at (870) 838-2955.
F
or Title IX & Affirmative Action issues, contact Jim McClain, VP for Student Affairs/Information Technology
P.O. Box 1109, Blytheville, AR 72316 or by calling (870) 762-1020
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