Fillable Application for Enrollment and Instructions (Community College of Rhode Island)

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Application for Enrollment and Instructions (Community College of Rhode Island)

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Apply online at www.ccri.edu/oes/admissions/learnhowtoapply.html
or follow the instructions below to apply by mail.
In Lincoln:
CCRI-Flanagan Campus
Oce of Enrollment Services
1762 Louisquisset Pike
Lincoln, RI 02865-4585
Personal data section
• Your Social Security number and date of birth are essential in processing your application. Your
Social Security number is mandatory under federal law.
• If applying without a social security number, please see http://www.ccri.edu/oes/admissions/
applicantwithoutssnortin.html
• Please note that if you are not a U.S. citizen, you may be asked to submit immigration
documentation as listed on the Application for Enrollment. Foreign students must contact the
Oce of Enrollment Services regarding visas and additional admissions documentation which
is required for attendance at the college.
• Questions pertaining to ethnicity and race are optional; however, answering these questions is
important in assisting the college in its armative action goals
Programs of interest section
• For campus codes and program names, refer to pages 2 through 4 of this application packet.
High school history section
• For high school codes, refer to page 5 of this packet. It is the applicant’s responsibility to provide the
Oce of Enrollment Services with ocial transcripts. Contact your high school guidance department
or GED
®
testing center to forward ocial transcripts or GED
®
scores to the college.
College history section
• List ALL colleges and universities previously attended, whether or not you wish to receive transfer credit.
For your convenience, some college codes are listed on page 5 of this packet. If your institution is not listed,
do not enter a college code on the application.
COMMUNITY COLLEGE OF RHODE ISLAND
Application for Enrollment and Instructions
In Warwick:
CCRI-Knight Campus
Oce of Enrollment Services
400 East Ave.
Warwick, RI 02886-1807
In Providence:
CCRI-Liston Campus
Oce of Enrollment Services
One Hilton St.
Providence, RI 02905-2304
In Newport:
CCRI-Newport County Campus
Oce of Enrollment Services
One John H. Chafee Blvd.
Newport, RI 02840
Degree and Certicate Programs*
COMMUNITY COLLEGE OF RHODE ISLAND
CCRI APPLICATION INSTRUCTIONS / PAGE 2 OF 7 8
/
2013
KN=Knight Campus
FL=Flanagan Campus
PV=Providence Campus
NE=Newport County Campus
A.A.=Associate in Art
A.S.=Associate in Science
A.A.S.=Associate in Applied Science
A.F.A.=Associate in Fine Arts
A.A.S.T.S.=Associate in Applied Science
in Technical Studies
^ Some, but not all, major courses offered
on this campus.
PROGRAM CODE DEGREE CAMPUS DAY EVENING
ADMINISTRATIVE OFFICE TECHNOLOGY
Administrative Assistant/Secretary ADAD A.S. KN FL + +
Basic Ofce Skills Certicate BOSC Certicate KN FL + +
Customer Service Specialist Certicate CSPC Certicate KN FL + +
Legal Administrative Assistant/Secretary LGAD A.S. FL + +
Legal Ofce Assistant Certicate LOAC Certicate FL + +
Medical Administrative Assistant/Secretary MDAD A.S. KN +
Medical Insurance Billing Specialist Certicate MIBC Certicate KN + +
Medical Transcription Certicate MEDT Certicate KN +
Ofce Administration Certicate OFAC Certicate KN FL + +
BIOTECHNOLOGY
Biotechnology Certicate BIOT Certicate KN + +
BUSINESS ADMINISTRATION
Accounting ACCT A.S. KN FL + +
Accounting Certicate ACTC Certicate KN FL + +
Entrepreneurship Certicate ETRC Certicate KN FL + +
Financial Services FNBK A.S. KN FL + +
Financial Services Certicate FNSC Certicate KN FL + +
General Business GBUS A.S. KN FL PV NE + +
Management MNGT A.S. KN FL + +
Management Certicate MGTC Certicate KN FL + +
Marketing MARK A.S. KN FL + +
Marketing Certicate MRKC Certicate KN FL + +
CHEMISTRY
Chemical Technology CHMT A.A.S. KN + +
Chemical Technology Certicate CHMC Certicate KN + +
COMMUNICATION
New Media Communication Certicate NMCC Certicate KN FL PV NE + +
COMPUTER STUDIES and
INFORMATION PROCESSING
Computer Programming CPRD A.S. KN + +
Computer Programming Certicate CPCT Certicate KN + +
Cybersecurity CYBR A.S. PV KN FL NE + +
General Information Processing CMGD A.S. KN + +
General Information Processing Certicate CMGC Certicate KN + +
Information Technology Support Specialist CMSD A.S. KN + +
Information Technology Support Specialist Certicate CMSC Certicate KN + +
Networking CMND A.S. KN + +
Networking Certicate CMNC Certicate KN + +
Ofce Automation Certicate OFFA Certicate KN + +
Web Technologies CWTD A.S. KN + +
Web Technologies Certicate CWTC Certicate KN + +
Degree and Certicate Programs*
COMMUNITY COLLEGE OF RHODE ISLAND
CCRI APPLICATION INSTRUCTIONS / PAGE 3 OF 7 8
/
2013
PROGRAM CODE DEGREE CAMPUS DAY EVENING
ENGINEERING and TECHNOLOGY
CNC Manufacturing and 3D-Modeling Certicate ETCA Certicate KN + +
Introduction to CNC Manufacturing Certifcate ETCI Certicate KN + +
Computer and Networking Technology CNTD A.A.S. KN + +
Computer Desktop Technology Track CDTO A.A.S. KN + +
Computer Networking Technology Track CNTO A.A.S. KN + +
Computer Desktop Technician Certicate CDTC Certicate KN + +
Networking Technician Certicate NWTC Certicate KN + +
Advanced Networking Technician Certicate NWAC Certicate KN + +
Energy Utility Technology Certicate ETUT Certicate KN + +
Engineering Systems Technology ETST A.S. KN + +
CNC Manufacturing Track ETCT A.S. KN + +
Electrical Track ETET A.S. KN + +
Energy Track ETPT A.S. KN + +
Mechanical Track ETMT A.S. KN + +
Engineering Transfer ENGN A.S. KN + +
Biomedical Track ENBI A.S. KN + +
Chemical Track ENCH A.S. KN + +
Chem-Biology Track ENCB A.S. KN + +
Civil Track ENCI A.S. KN + +
Computer Track ENCM A.S. KN + +
Electrical Track ENEL A.S. KN + +
Industrial Track ENIN A.S. KN + +
Mechanical Track ENME A.S. KN + +
Ocean Track ENOC A.S. KN + +
FINE ARTS
Art ARTS A.F.A. PV KN FL NE + +
Theatre THEA
Performance Track DRAM A.F.A. KN FL +
Technical Track TDRA A.F.A. KN FL +
Music
Jazz Studies Track JAZZ A.F.A. KN +
Music Track MUSC A.F.A. KN +
GENERAL STUDIES
General Studies GENS A.A. PV KN FL NE + +
HEALTH SCIENCES
ALLIED HEALTH PROGRAMS
Diagnostic Medical Sonography DMSD A.A.S. FL + +
Histotechnician HSTO A.A.S. PV + +
Magnetic Resonance Imaging Certicate MRIC Certicate FL + +
Medical Laboratory Technology CLAB A.A.S. FL +
Phlebotomy Certicate PHLE Certicate PV + +
Radiography (X-ray) XRAY A.A.S. FL +
Renal Dialysis Technology Certicate RENL Certicate PV +
Respiratory Therapy RESP A.A.S. FL +
DENTAL HEALTH PROGRAMS
Dental Assisting Certicate DAST Certicate FL +
Dental Hygiene DHYG A.A.S. FL +
EMERGENCY/DISASTER MANAGEMENT
Degree and Certicate Programs*
COMMUNITY COLLEGE OF RHODE ISLAND
CCRI APPLICATION INSTRUCTIONS / PAGE 4 OF 7 8
/
2013
*Programs are subject to change at any time.
Emergency Management/Homeland Security EMGD A.S. KN FL PV NE +
Emergency/Disaster Management Certicate EMER Certicate KN FL PV NE +
Fire Science/Emergency Medical Technician FIRE A.A.S. KN FL PV NE + +
Homeland Security Certicate HMLS Certicate KN FL + +
NURSING PROGRAMS
Nursing
(Previous curriculum for students enrolled prior to Fall 2016) NURS A.S. or Diploma KN PV FL NE + +
Nursing
(NEW curriculum for students enrolled in Fall 2016 and after) NURS A.S. or Diploma KN PV FL NE + +
Health Care Interpreter Certicate INTC Certicate PV +
REHABILITATIVE HEALTH PROGRAMS
Occupational Therapy Assistant OCTA A.A.S. NE +
Opticianry OPTI A.A.S. DL/NE +
Physical Therapist Assistant PHTA A.A.S. NE +
Therapeutic Massage TMSG A.A.S. NE +
Therapeutic Massage Certicate TMSC Certicate NE +
HOSPITALITY
Culinary Arts Assistant Certicate CULN Certicate FL + +
Hospitality Certicate HOSP Certicate KN, FL + +
Travel and Tourism Certicate TRVL Certicate KN, FL + +
HUMAN SERVICES
Early Childhood Education and Child Development CHLD A.A. PV KN FL +
Developmental Disabilities Certicate 173 CDVD Certicate KN FL +
Early Childhood Education Certicate 174 CHLC Certicate PV KN FL +
Education/Special Education ESPE A.A. KN FL +
Gerontology Certicate GERN Certicate KN PV FL NE + +
Social Service Majors:
Gerontology GERN A.A. KN FL +
Mental Health MNTL A.A. PV KN FL +
Social Work SOWK A.A. PV KN FL +
Substance Abuse SUBS A.A. KN FL +
Social Services Certicate CSOS Certicate PV KN FL +
LEGAL STUDIES
Law Enforcement LENF A.S. PV KN FL NE^ + +
Paralegal Studies PALG A.S. PV KN FL NE^ + +
LIBERAL ARTS
Liberal Arts LIBA A.A. PV KN FL NE + +
Liberal Arts – English LAEN A.A. KN FL + +
Liberal Arts – Foreign Languages LAFL A.A. KN FL + +
Liberal Arts – Mathematics LAMA A.A. KN FL + +
SCIENCE
Science SCID A.S. KN FL + +
TECHNICAL STUDIES
Technical Studies TECH A.A.S.-T.S. KN FL + +
PROGRAM CODE DEGREE CAMPUS DAY EVENING
PROGRAM CODE DEGREE CAMPUS DAY EVENING
High School and College Codes
COMMUNITY COLLEGE OF RHODE ISLAND
High School Codes
Academy for Career Exploration .....................................................400146
(formerly Textron Chamber of Commerce Academy)
Alternate Learning Project.................................................................400143
Dr. Jorge Alvarez High School ..........................................................400001
Apponaug Christian Academy ...........................................................400241
Aquidneck Island Christian Academy ..............................................400129
Attleboro High School ........................................................................220073
Barrington Christian Academy..........................................................400002
Barrington High School ......................................................................400000
Beacon Charter School ......................................................................400282
Bellingham Memorial Jr.-Sr. High School ........................................220117
Bishop Connolly Regional High School ...........................................220783
Bishop Feehan High School ...............................................................220077
Bishop Hendricken High School .......................................................400238
Bishop Keough Regional High School .............................................400099
Blackstone Academy Charter School ..............................................400100
Blackstone-Millville Regional High School ......................................220160
Blackstone Valley Baptist Academy .................................................400038
Blackstone Valley Reg. Voc. Tech. High School ............................222154
Block Island High School ....................................................................400005
Burrillville High School .......................................................................400055
Case High School .................................................................................222105
Central Falls High School ...................................................................400012
Central High School ............................................................................400145
Chariho High School ...........................................................................400270
Classical High School ..........................................................................400150
Convent of the Sacred Heart ............................................................409001
Coventry High School.........................................................................400030
Coyle-Cassidy Memorial High School ............................................222120
Cranston High School East ................................................................400035
Cranston High School West .............................................................400036
Cumberland High School ...................................................................400037
Davies Career and Technical High School .....................................400057
Dighton-Rehoboth Regional High School .....................................221645
Durfee High School ............................................................................220785
E 3 Academy .........................................................................................400157
East Greenwich High School ........................................................... 400040
East Providence High School ........................................................... 400050
Elmhurst Academy ............................................................................. 409003
Exeter-West Greenwich
Regional Jr.-Sr. High School .........................................................400252
Feinstein High School ..........................................................................400154
First Baptist Christian School ............................................................400242
Fletcher Preparatory ..........................................................................409004
Foxborough High School ..................................................................220840
GED
®
credentials ..................................................................................409999
Global Learning Public Charter School...........................................221488
Greene School ......................................................................................400254
Highlander Charter School ................................................................ 400243
Hope High School ..............................................................................400155
Immaculate Conception Academy ...................................................400227
Johnston High School .........................................................................400058
Killingly High School ............................................................................070135
King Phillip Regional High School ....................................................222562
La Salle Academy ................................................................................400160
Lincoln High School ...........................................................................400059
Lincoln School (Providence) ............................................................400165
Manseld High School .........................................................................221320
Masters Regional Academy ................................................................400220
The Metropolitan Regional Career
and Technical Center .....................................................................400166
Middletown High School ...................................................................400063
Milton High School ..............................................................................221440
Moses Brown School ..........................................................................400180
Mount Hope High School
(formerly Bristol High School) ...........................................................400010
Mount Pleasant High School ..............................................................400185
Mount St. Charles Academy ..............................................................400285
Narragansett High School ..................................................................400064
New England Academy of Torah (Hebrew Day)..........................400187
New England Laborers’/Cranston Public School
Construction Academy ..................................................................400034
North Attleboro High School ...........................................................221625
North Kingstown High School..........................................................400088
North Providence High School .......................................................400090
North Smitheld High School ...........................................................400287
Norton High School ............................................................................221670
Ocean Tides School ............................................................................400066
Our Lady of Fatima High School .....................................................400236
Paul Cuffee High School .....................................................................400006
Pilgrim High School .............................................................................400239
Plaineld High School ..........................................................................070090
Ponaganset High School .....................................................................400093
Portsmouth Abbey School .................................................................400130
Portsmouth High School ....................................................................400128
Paul J. Primavera Educational Center ...............................................220116
The Prout School .................................................................................400228
Providence Career and Technical High School ............................400142
Providence Country Day School ....................................................400045
Rhode Island Nurses Institute Middle College ............................400141
Rhode Island School for the Deaf ....................................................400189
Rocky Hill School .................................................................................400043
Rogers High School .............................................................................400075
Juanita Sanchez Complex ...................................................................400183
(formerly the Providence Academy of International Studies and
William Cooley Health, Science and Technology Academy)
School One ............................................................................................400188
Scituate Jr.-Sr. High School ................................................................400095
Seekonk High School ..........................................................................221891
Shea High School (Pawtucket West) ...............................................400125
Smitheld High School ........................................................................400053
South Kingstown High School...........................................................400230
St. Andrew’s High School .................................................................400250
St. Dunstan’s Day School ...................................................................400193
St. George’s High School ...................................................................400085
St. Mary Academy (Bay View) ...........................................................400215
St. Raphael Academy ...........................................................................400110
Taunton High School ..........................................................................222123
Times 2 Academy.................................................................................400144
Tiverton High School ..........................................................................400224
Tri-County Reg. Voc. Technical High School ................................220864
Trinity Academy for the Peforming Arts .........................................400210
Trinity Christian Academy .................................................................400060
Toll Gate High School.........................................................................400237
Tolman Senior High School ...............................................................400115
U.S. Naval Academy Prep School .....................................................400068
Uxbridge High School .........................................................................222155
Jacqueline M. Walsh School of
Performing and Visual Arts ...........................................................400969
Warren High School ...........................................................................400235
Warwick Veterans High School .......................................................400240
West Warwick High School ..............................................................400265
Westerly High School .........................................................................400255
The Wheeler School ...........................................................................400170
Woonsocket High School ..................................................................400295
Other ......................................................................................................409666
Out-of-Country ....................................................................................409777
Out-of-State (if not listed above) ........................................................409888
COLLEGE CODES
Bridgewater State University ................................................................. 3517
Bristol Community College .................................................................. 3110
Bryant University ..................................................................................... 3095
Community College of Rhode Island .................................................. 3733
Dean College ............................................................................................ 3352
Fisher College ........................................................................................... 3391
Johnson & Wales University .................................................................. 3465
New England Institute of Technology ................................................. 0339
Providence College .................................................................................. 3693
Rhode Island College .............................................................................. 3724
Roger Williams University ..................................................................... 3729
Salve Regina University .......................................................................... 3759
University of Massachusetts-Dartmouth ............................................ 3786
University of Rhode Island .................................................................... 3919
CCRI APPLICATION INSTRUCTIONS / PAGE 5 OF 7 8
/
2013
APPLICATION FOR ENROLLMENT
Tell us about your interest in CCRI. Please share this information with us so that we can better advise you on your best course of action at CCRI.
First time in college. I have not attended college previously.
Returning. I previously attended CCRI.
Nondegree. I am enrolled at another college or university, taking classes at CCRI, but not pursuing a degree at CCRI; or I am interested in taking
courses for personal or professional reasons.
Transfer. I am entering CCRI and I have previous college-level coursework.
Personal data: Complete this form after you have reviewed our program listings. Please print clearly.
Previous name
Permanent home street address
Are you a U.S. citizen?
Yes
No
If you are not a U.S. citizen, do you have a Permanent Resident Card (Green Card)?
Yes
No
If you are a permanent resident card holder, please provide your alien registration number.: _____________________________________________________
Have you lived continuously in Rhode Island for one or more years as of the rst day of classes for this semester?
Yes
No
Is Rhode Island your legal and permanent state of residence?
Yes
No
If you have a non-Rhode Island permanent home address and you are claiming Rhode Island residency, you must submit a CCRI Application for In-State Residency and all
required documentation. This information is available at wwww.ccri.edu/oes/admissions/pdfs/resusperm.pdf
If you are not a legal and permanent resident of Rhode Island, please list your legal residence.
Street
_______________________________________________________City _________________________________________State _______ ZIP _____________ Country____________________________
Are you a recipient of the Supplemental Nutrition Assistance Program (SNAP)?
Yes
No
Service members or dependents
Did you serve or are you serving in the U.S. armed forces?
Yes
No
N/A
If you or your dependents are currently serving, are you stationed in Rhode Island on active duty?
Yes
No
N/A
Will you be using VA education benets at CCRI?
Yes
No
N/A
Will you be using VA education benets as a dependent at CCRI?
Yes
No
N/A
Did you honorably serve in a combat zone?
Yes
No
N/A
Please note:
• Applicants in Refugee Status, Temporary Protected Status, or Political Asylum Status must mail a copy of the documentation of their status.
• Other visa or immigration status: Please mail a copy of your Visa, I-797 or other documentation.
Misrepresentation concerning residency and/or citizenship is grounds for immediate dismissal from the college, but you will rem
ain liable for all tuition and fees.
Date of birth (mm/dd/yy)
Home telephone number
Social Security number
Gender
:
Cell number
Please text me important college information regarding enrollment,
nancial aid and other key milestones in my academic progress
Date of application
City
(as it appears on Social Security card or U.S. passport)
Email address
State/Zip
Last name
First name
Middle initial
Middle initial
The following information helps us comply with federal statistical reporting requirements only and will not, in any way, impact an admission
decision on your application. Federal regulations require colleges to report enrollment data by racial, ethnic and gender categories.
Ethnicity: (Not used for admission. Please check one.)*
Not Hispanic
Hispanic or Latino
Federal regulations require colleges
to report enrollment data by racial, ethnic
and gender categories
Race: (Not used for admission. You may check more than one race.)
American Indian or Native American
Asian
Black or African American
Important information:
One or both parents (biological or adoptive) earned a four-year degree
Yes
No
Single parent with custody of a child under 18
Yes
No
Speaker of English as a second language
Yes
No
Displaced homemaker
†
Yes
No
* Ethnicity/Race data reporting for federal purposes has changed. The selections that you see in this section are the choices as mandated by the federal government for higher education
reporting purposes. Only statistical numbers are reported. No individual data appears on the federal reports.
†
Thetermdisplacedhomemakerreferstowomenormenwhohaveworkedmainlyinthehomeforaminimumoftwoyearscaringforhomeandfamily.Duetolossoffamilynancial
support (usually through death, disability or divorce), these individuals must leave the home and seek to support themselves and their families.
For Oce Use
CCRI ID Number: ForOceUse
Native Hawaiian or Pacic Islander
White
Social Security number is mandatory under federal law. If applying without a social
security number see http://www.ccri.edu/oes/admissions/applicantwithoutssnortin.html
Yes
No
College/University name Code City State Degree
College/University name Code City State Degree
College/University name Code City State Degree
Programs of interest: Please indicate your program choices. Please print clearly.
What program of study are you interested in pursuing?
I am interested in a degree program
1st choice ________________________ ______________________________________________________________________________
2nd choice ________________________ ______________________________________________________________________________
At this time, I am interested in applying as a nondegree student
(Please note: Financial aid, including on-campus work programs, is not available to nondegree students.)
Are you interested in receiving information about the Joint Admissions Agreement (JAA) among the Community College of Rhode Island, Rhode Island College
and the University of Rhode Island?
Yes
No, thank you
Campus
Program of study name
Campus
Program of study name
Year
High school history: Please complete as appropriate. Please print clearly.
I have or will have:
High school diploma
Institution name, city, state
GED
®
credential
State in which GED
®
credential was received
Home school diploma — Please submit documentation from your local school district
approving your home schooling program.
Institution name, city, state
I do not hold any of the above.
Code
Please forward a copy of your nal ocial high school transcript or GED
®
credential to the Oce of Enrollment Services as soon as available.
Diploma Date
Month / Day / Year
College history: Please list ALL undergraduate colleges and universities attended. (Please submit ocial transcripts from each
school to the Oce of Enrollment Services, 1762 Louisquisset Pike, Lincoln, RI 02865.) Please print clearly.
COLLEGE 1:
COLLEGE 3:
COLLEGE 2:
_______________________________________________________________________________ ______________________________________________________ _________________ ________________________
Agreements:
I certify that the information that I have provided on this application is true and correct. Further, by signing this form, I agree to abide by the rules and regulations
at, and fulll all nancial obligations to, the Community College of Rhode Island
.
Acceptance Checkbox
I understand that checking this box constitutes a legal signature conrming that I acknowledge and agree to the above Terms of Acceptance.
For Oce Use Only
NEBHE __________________
Code
Date Received
Month / Day / Year
Code
Date Received
Month / Day / Year
Intended Entry Date
January/Spring
September/Fall
Summer
CCRI APPLICATION 12
/
2018
Applicant's signature Application date
Do you have a bachelor’s degree from a U.S. college or its equivalent from a school in another country?
Yes
No
If yes, indicate the degree received below.
_______________________________________________________________________________ ______________________________________________________ _________________ ________________________
_______________________________________________________________________________ ______________________________________________________ _________________ ________________________
If under age 18, signature of parent/guardian Application date
Please type your First and Last Name
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Application for Enrollment and Instructions (Community College of Rhode Island)

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