Fillable Application for Admission (Lamar Community College)

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Application for Admission (Lamar Community College)

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Lamar Community College
2401 South Main
Lamar, CO 81052
Phone: 719.336.1590 or 800.968.6920
Fax: 719.336.2400
Application for Admission
Please indicate the year and term you wish to enroll:
20_____ Summer _____ Fall _____ Spring _____
Social Security Number:* _________________________ SASID (Your CO High School ID Number): _____________________________
*Your SSN is not required but is used to match past/future records, and is required for education tax credits, and some financial aid.
Last Name: ___________________________________ First Name: ____________________________ Middle Name: ______________________
Previous Name (if applicable): _______________________________________________ Birth date: __________________________(MM/DD/YY)
Local/Mailing Address
Street: ________________________________________________________________________________ City: ___________________________
County: ________________________ State: ________________ Zip: ___________ Country: __________________________ (if not U.S.)
Preferred Phone Number: _________________________ Personal email address: ___________________________________________________
Permanent Address (If different from Local/Mailing Address)
Street: ________________________________________________________________________________ City: ___________________________
County: ________________________ State: ___________ Zip: ___________ Country: ____________ (if not U.S.)
Veteran/Military Service
_____ None
_____ Veteran or Dependent
_____ Active Duty Veteran
_____ Active Duty Military
Branch of Service:
_____________________
Current Employment Status
_____ Full-time (30+ hrs/week)
_____ Part-time (1-29 hrs/week)
_____ Not employed
While at this College do you intend to:
_____ Earn an AA, AS, or AGS degree
_____ Earn a technical degree (AAS)
_____ Earn a certificate
_____ Take a few courses for transfer to another college
_____ Take a few courses for job or career reasons
_____ Attend for personal interest
_____ None of the above
Gender
_____ Male
_____ Female
Do you consider yourself economically disadvantaged? Yes _____ No _____
Is English your second language? Yes _____ No _____
Do you consider yourself a displaced homemaker? Yes_____ No _____
Do you consider yourself a single parent? Yes _____ No _____
Are you a first generation college student? Yes _____ No _____
If no, which of your parents attended college? Mother _____ Father _____
What best describes your current status?
New student, no college or university experience _____
Transfer student, some college or university experience _____
Readmit, I am returning to this college _____
WHAT IS YOUR INTENDED PROGRAM OF STUDY?
____________________________________________________
If you are unsure of your program choice, choose Associate of Arts
or Associate of Science if you ARE planning to transfer, or an
Associate of General Studies or Associate of Applied Science if you
are NOT planning to transfer.
Which best describes the level of education you have
completed?
_____ Less than high school
_____ High school graduate
_____ Earned a GED
_____ Certificate
_____ Associates degree (AA, AS, AGS, AAS)
_____ Bachelors degree
_____ Masters degree
_____ Doctorate (Ed.D., Ph.D.)
_____ Professional degree (MD., JD, MBA)
High School/GED Information
High School Name: __________________________________
City: ____________________
Currently enrolled in high school? Yes _____ No _____
If yes, expected graduation date: ____________
If no, graduation date if applicable: ____________
GED completed? Yes _____ No _____
If, yes date? _____________
State completed: _____________
Selective Service Statement
Colorado state law requires that
all males who are at least 17
years & 9 months of age but
younger than 26 years answer
the following question.
Are you registered with the
Selective Service?
Yes _____ No _____
You can register for selective
service at www.sss.gov
Most Recent Prior College (If applicable)
Name of College:________________________________________________________________________________
City: _________________________ State: _________ Years of Attendance: ____________________________
Citizenship
U.S Citizen _____ Non U.S. Citizen _____
Country of Origin ____________________
Visa Type: ___________________________
Visa Expiration Date: ______-______-______ (MM-DD-YY)
Ethnicity (for federal reporting) Race (select one or more)
_____ Hispanic or Latino _____ American Indian or Alaskan Native
_____ Not Hispanic or Latino _____ Asian
_____ Black or African American
_____ Native Hawaiian or Pacific Islander
_____ White
College Opportunity Fund (COF) provides a stipend to eligible undergraduate students. The stipend
pays a portion of your total in-state tuition. You must apply online at www.CollegeinColorado.org in
order to receive this stipend.
Residency Questions – Please answer the following questions. Failure to answer a question may result in your being misclassified for tuition
purposes. Please contact the Office of Admissions if you need assistance.
Questions for Colorado high school students
For the last three years, were you enrolled in a Colorado high school? Yes _____ No _____
Did you or will you graduate from a Colorado high school before you enroll in College? Yes _____ No _____
Questions for GED recipients
Did you earn your GED in Colorado? Yes _____ No _____ If yes, have you resided in Colorado for the last three years? Yes _____ No _____
Additional Residency Questions – All Students
If you are under the age of 23 and not married please answer the questions for your parent or guardian. If you are over 23 or under 23 and
have been married for at least a year please provide only your information.
What is your current age? ______
Parent _____ Guardian _____
Your Information
Dates of continuous physical presence in
Colorado.
_________ (mm/yy) to _________ (mm/yy)
_________ (mm/yy) to _________ (mm/yy)
List any dates of extended absences from
Colorado in the last two years.
_________ (mm/yy) to _________ (mm/yy)
_________ (mm/yy) to _________ (mm/yy)
List the last two years Colorado income taxes
have been filed.
_________ (year) and ________ (year)
_________ (year) and ________ (year)
Current driver’s license or identification card.
Date Issued: _________________
New _______ Renewal _______
Number _____________________
State _______________________
Do not have license or ID card _____
Date Issued: _________________
New _______ Renewal _______
Number _____________________
State _______________________
Do not have license or ID card _____
List the last two years of Colorado motor vehicle
registration.
__________ (mm/yy) and __________ (mm/yy)
Not applicable ______
__________ (mm/yy) and __________ (mm/yy)
Not applicable ______
List the dates of employment in Colorado.
__________ (mm/yy) and __________ (mm/yy)
Not applicable ______
__________ (mm/yy) and __________ (mm/yy)
Not applicable ______
Date of Colorado voter registration.
_______________ (mm/yy)
_______________ (mm/yy)
If you are active duty military or a dependent of an active duty military service member assigned to a Permanent Change of Station in Colorado, you may
be eligible for in-state tuition rates. Contact your military base Education Office for documentation.
I hereby certify that to the best of my knowledge the information furnished in this application is true and
complete without the intent of evasion or misrepresentation. I understand that if the above information
submitted is found to be false or misrepresented it is subject to penalty of perjury and is sufficient cause for
tuition reclassification or dismissal.
________________________________ __________________________________ ____________
Applicant Signature Parent or Legal Guardian if Applicant is under 18 Date
Institutions using this application form do not discriminate on the basis of race, color, national origin, gender, age, or disability in
admission or access to its education programs or activities. Inquiries concerning Title VI, IX and Section 504 may be referred to the
affirmative action officer of the institution to which you are applying.
For office use only: Student ID: ___________________________Program of Study Code: ___________________
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Application for Admission (Lamar Community College)

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Completed 25 July 2020

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