School of Extended Learning
NONCREDIT APPLICATION FOR ADMISSION
(Adult High School or GED)
Term Applying For:
□ Summer □ Fall □ Spring
Year______
Full Legal Name:
LAST:_____________________________________________________
FIRST:____________________________________________________
MIDDLE:__________________________________________________
Previous Name on Academic Records:
LAST:__________________FIRST______________MIDDLE__________
Email: ___________________________________________________
Date of Birth: ______/______/_______ Age:________
(Minor Enrollment form required if under 18 years of age)
Gender: □ Male □ Female □ Decline to state
Current Mailing Address:
_________________________________________________________
Number & Street Apt.
_________________________________________________________
City State Zip
Country, if other than U.S. ___________________________________
Telephone Number ( )___________________________________
Educational Level:
(As of the start of application term, you are or will be)
□ (0) Not a graduate of, and no longer enrolled in high school
□ (1) Currently enrolled in K-12 (high school)
□ (2) Enrolled in Adult High School
□ (3) Received high school diploma from U.S. school
□ (4) Passed the GED/received a High School Certificate of Equivalency
□ (5) Received a Certificate of California High School Proficiency
□ (6) Received diploma of graduation from a foreign Secondary School
□ (7) Associate Degree
□ (8) Bachelor Degree or higher
Race/Ethnicity :
Are you of Hispanic or Latino ethnicity? □ Yes □ No (check one or more)
□ 01- Hispanic, Latino
□ 02- Mexican, Mexican-
American, Chicano
□ 03- Central American
□ 04- South American
□ 05- Hispanic Other
□ 06- Asian Indian
□ 07- Asian Chinese
□ 08- Asian Japanese
□ 09- Asian Korean
□ 10- Asian Laotian
□ 11- Asian Cambodian
□ 12- Asian Vietnamese
□ 13- Filipino
□ 14- Asian Other
□ 15- Black or African American
□ 16- American Indian/Alaskan
Native
□ 17- Pacific Islander Guamanian
□ 18- Pacific Islander Hawaiian
□ 19- Pacific Islander Samoan
□ 20- Pacific Islander Other
□ 21- White
Education Goal:
Parents / Guardian Education Level:
(Regardless of your age, please indicate the education levels of
the parents and/or guardians who raised you)
Parent / Guardian #1
□ (1) Grade 9 or less
□ (2) Some high school; did
not graduate
□ (3) High School graduate
□ (4) Some college; no
degree
□ (5) Associate’s Degree
□ (6) Bachelor’s Degree
□ (7) Graduate or
professional degree
beyond BA/BS
□ (X) Unknown
□ (Y) No parent or guardian
Parent / Guardian #2
□ (1) Grade 9 or less
□ (2) Some high school; did
not graduate
□ (3) High School graduate
□ (4) Some college; no
degree
□ (5) Associate’s Degree
□ (6) Bachelor’s Degree
□ (7) Graduate or
professional degree
beyond BA/BS
□ (X) Unknown
□ (Y) No parent or guardian
To be signed by all students
I declare under penalty of perjury that the statements submitted by me
are true and correct. All materials submitted by me for the purposes of
admission become the property of Santa Barbara City College. I
understand that falsification, withholding pertinent data, or failure to
report change in residence may result in my dismissal.
Student
Signature:_______________________________Date________
OR: Power of Attorney/Trustee
Signature:_______________________________
(L) Complete credits for high school diploma or GED
Intended Major/Program of Study:
□ High School Diploma (includes credit recovery) (AH-AHSDPL-D)
□ GED (AH-GEDSTD-CC)
□ Bilingual GED (AH-GEDBIL-CC)
High School Last Attended
______________________________________
High School Name
_______________________________________________
Number & Street Apt.
_______________________________________________
City State Zip
Country, if other than U.S.__________________________
Date:__________________
Prior College(s): (attach separate sheet if needed)
_______________________________________
College Name
______________________________________________
Number & Street Apt.
____________________________________________
City State Zip
Country, if other than U.S.__________________________
Attended: From(MM/DD/YYYY)_______To (MM/DD/YYYY)______
