Fillable Application for AdmissionBasic Law Enforcement Training (Mitchell Community College)

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Application for AdmissionBasic Law Enforcement Training (Mitchell Community College)

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MCC-784 Equal Opportunity College/Affirmative Action Employer Rev. 03/18
Application for Admission—Basic Law Enforcement Training
Mail or submit to: Law Enforcement Training Center
Mitchell Community College
701 West Front Street
Statesville, NC 28677
(704) 878-3255
Visit our Web site at
mitchellcc.edu
Please print in ink. Answer all questions completely. Use legal name only. This data is used to maintain appropriate records. Sex and race
information is voluntary and will not be used in decisions regarding admissions.
Enrollment Term
Spring Day Fall Day Fall Night Fall Alternating
Year _________________
Are you a returning student?
Yes No
Last Name
Middle
Former
Mailing Address
City
State
Zip Code
County of Legal Residence
State of Legal Residence
Country of Legal Residence
Home Phone
Mobile Phone
Email Address
Date of Birth
Are you Hispanic or Latino? Yes No
Gender
Female Male
Social Security #
Select one or more races American/Alaska Native Asian
Black or African-American Hawaiian/Pacific Islander White
Long-term goal at Mitchell Community College (Check one.)
GR Obtain an Associate Degree, Diploma, or Certificate TR Take courses to transfer to another college
EP Enhance job skills in present field of work PE Take courses for personal enrichment or interest
EN Enhance employment skills for a new job
Citizenship (Select one.)
U.S. Citizen Refugee
Permanent Resident Alien Asylee
Non-U.S. Citizen
Information supplied on this application is in no way used as criteria for admissions. It is used for institutional statistical purposes and is held in strict
confidence. It is the policy of Mitchell Community College not to discriminate against any person on the basis of race, color, handicap, sex, religion, or
national origin in the recruitment and admission of students.
REQUIRED—Must provide to complete the admissions process
Residency Certification (RCN) # ____________________________________________
To obtain your RCN, visit www.ncresidency.org
MCC-784 Equal Opportunity College/Affirmative Action Employer Rev. 03/18
Military Service
Are you a veteran? Yes No Are you eligible for VA education benefits? Yes No
Are you Active Duty Military Military Dependent Neither
Plan to attend
Full-time
Part-time
Employment status (Check one.)
Retired Employed 21-39 hours per week Unemployed, seeking employment
Employed 1-10 hours per week Employed 40 or more hours per week Unemployed, not seeking employment
Employed 11-20 hours per week
High School Information
High School Last Attended
City
County
State
Yes, I graduated
Graduation Date
No, I did not graduate
Last Date of Attendance
I received an Adult High
School Diploma
School
State
City
Date Received
I received a High School
Equivalency Diploma
School
State
City
Date Received
I am currently enrolled in High
School
School
State
City
Anticipated Grad. Date
High School Track (check one)
College Prep Technical Prep Both Unknown/NA
Other Colleges Attended
City
State
Date Last Attended
Highest education level completed (Check one.)
8 11 13 Adult High School Diploma 16 Bachelor’s Degree
9 12 14 Post High School Vocational 17 Master’s Degree or Higher
10 High School Equivalency Diploma 15 Associate Degree
Name of person to contact in case of emergency
Phone
I hereby certify that the information I have given is true to the best of my knowledge. I further understand that falsification or failure to supply the correct
information may be considered grounds for rejection or dismissal.
*Applicant Signature _________________________________________________________________________________ Date __________________________________
*Applicant signature REQUIRED
Please mail this application to the following address:
Law Enforcement Training Center
Mitchell Community College
701 West Front Street
Statesville, NC 28677
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Application for AdmissionBasic Law Enforcement Training (Mitchell Community College)

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Completed 1 October 2020

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