Graduation type: (Check the type that best describes your highest educational background)
High School Last Attended
SIGNATURE REQUIRED Read the following CAREFULLY before signing
I declare under penalty of perjury that the statements and information submitted in this Admissions Application are true and correct. I understand that all materials submitted by
me for purposes of admission are true and correct. Falsification, withholding pertinent data or failure to report changes in residency or education status may result in District
action. I understand that all materials submitted by me for purposes of admission become the property of the San Jose/Evergreen Community College District. In registering for
future terms, I agree to provide true and correct information about any changes in my educational status.
(No SS#, Add ID# to DADD)
State laws regulate student fees on the basis of California residence.
This statement is a certification necessary to administer the laws.
A From the date of this application, have you continuously lived in California for at least one year and one day?
B If you answered NO to part A, and you want to be considered a California resident for enrollment purposes, answer the residency questions
Are you an active member of the US military or a dependent?
Are you a dependent of a parent who is a California resident?
Have you, or if you are under 19 years of age, have your parents, any time during the past two years:
Registered to vote in a state other than California?
Petitioned for divorce in another state?
Been declared a non-resident of California for state income tax purposes?
Attended an out-of-state institution as a resident of that other state?
If you are unmarried and under 19 years of age, have you lived with one or both parents for the past two years at a California address?
C Citizenship Select ONE.
4 Currently enrolled in
adult high school
1 Received a high school
2 Passed GED/ certificate
3 Received Certificate of
Cal. H.S. Proficiency
7 Foreign secondary school diploma /Certificate
8 Received Associate’s Degree
9 Received Bachelor’s Degree or higher
6 Special admit student currently
enrolled in K-12th grades
5 Not a graduate of, and no longer
enrolled in high school
No, list where you lived previously and the beginning and ending dates of your residence in that state or country.
No, but I am eligible for AB-540 status.
What state do you consider as your permanent home?
If California, when did your present stay begin (Month/Day/Year)?
Temporary Resident / Amnesty
Student Visa (F-1 or M-1)
AB-540 Eligible (see Schedule for details)