Fillable Student Information Update Ccs 40-194 (Spokane Community College)

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Student Information Update Ccs 40-194 (Spokane Community College)

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CCS 40-194 03/20
Page 1 of 2
Marketing and Public Relations
Community Colleges of Spokane
STUDENT INFORMATION UPDATE
Identify campus:
Colville
Inchelium
Ione
Newport
Republic
Running Start
Spokane Falls Community College (SFCC):
Admissions Office MS 3011
3410 W Fort George Wright Dr
Spokane WA 99224-5288
www.spokanefalls.edu
Pullman
Fairchild
Running
Start
PLEASE PRINT IN BLUE OR BLACK INK ONLY.
When do you plan to return? Year
Summer (July-Aug.) Fall (Sept.-Dec.) Winter (Jan.-March) Spring (April-June)
Name
Last (legal)
First
M.I.
CTCLINK IDENTIFICATION NUMBER (### ### ###)
Other Name(s) Used
Date of Birth
Mailing Address
City
State
ZIP
SOCIAL SECURITY NUMBER (### ### ###)
E-mail address
To comply with federal laws, we are required to ask for your Social Security Number (SSN) or Individual
Taxpayer Identification Number (ITIN). We will use your SSN/ITIN to report Hope Scholarship/Lifetime
Learning tax credit; to administer state/federal financial aid; to verify enrollment, degree and academic
transcript records; and to conduct institutional research. If you do not submit your SSN/ITIN, you will not be
denied access to the college; however, you may be subject to civil penalties (refer to Internal Revenue Service
Treasury Regulation 1.6050S-1(e)(4) for more information). Pursuant to state law (RCW 28B.10.042) and
federal law (Family Educational Rights and Privacy Act), the college will protect your SSN from unauthorized
use and/or disclosure. If you refuse to provide your SSN, please write “REFUSED” in the SSN boxes to the
left. Contact the CCS Business Office at 509-434-5275 with questions.
Phone
PROGRAM OF STUDY
Program of Study (PROGRAMS LISTED ON OTHER SIDE)
RESIDENCY STATUS
1. Are you a US Citizen?
Yes No
2. Have you lived in the State of Washington for the past 12 consecutive months?
Yes No
3. Do you have a driver’s license or state ID?
Yes No
4. If you have a driver’s license or state ID, which state was it issued?
State:
5. Are you active duty military or the spouse or dependent of an active duty military member?
If you answered “Yes”, submit a copy of your Military ID and PCS (Permanent change of Station) Orders.
Yes No
6. Are you a Washington National Guard member or the spouse or dependent of a Washington National
Guard member? If you answered “YES”, submit a copy of your Military ID.
Yes No
List any colleges you attended other than SCC/SFCC.
NAME
CITY
STATE
YEAR
List high school attended:
Did you graduate? Yes No
GED? Yes No
Indicate HS graduation or GED earned date (MM/YYYY):
APPLICANT’S SIGNATURE
I understand that my request to change my current program may affect my financial aid eligibility and/or award
amount. I also understand this change may impact my time to degree completion. I certify that my responses on this
form are true.
Required applicant’s signature
Date
OFFICE USE ONLY
Date Received:
Received by:
Letter
Processed by
Res Code
Community Colleges of Spokane shares educational records within the district.
Community Colleges of Spokane does not discriminate on the basis of race, color, creed, religion, national origin, sex, sexual orientation, age, gender, marital
status, disability, or status as a disabled or Vietnam era veteran.
CCS 40-194 03/20
Page 2 of 2
Marketing and Public Relations
SPOKANE COMMUNITY COLLEGE
Accounting Assistant AAS
Accounting Clerk - Cert
Administrative Assistant AAS
Administrative Clerical Assistant - Cert
Administrative Office Management AAS
Agriculture Business AAS
Agriculture Business - Cert
Agriculture Tech AAS
Agriculture Tech - Cert
Spray Tech - Cert
Arboriculture/Urban Forestry AAS
Arboriculture/Urban Forestry - Cert
Architectural Tech AAS
Architectural Tech AAS-T
Architectural Tech - Cert
Associate in Science Track 1 Bio/Envr/Chem/Geol/Earth
Automotive Collision & Refinishing Tech AAS
Automotive Maint & Light Repair - Cert
Automotive Tech AAS
Automotive Toyota T-Ten AAS
Aviation Maint AAS
Airframe Maint - Cert
AMT Avionics Cert (Summer only)
Gen Aircraft Maint - Cert
Powerplant Maint - Cert
Bachelor of Applied Science Respiratory Care
Registered Respiratory Therapist
to BAS Degree Advancement
Baking: Prof Pastries & Specialty Cakes - Cert
Biomedical Equipment Tech AAS
Business, Gen AAS
Business, Gen Entrepreneurship Option - Cert
Project Management/Lean/Six Sigma Cert
Business Occupations - Cert
CAD – CAD Design & Drafting AAS
CAD – CAD Design & Drafting - Cert
Career Studies - Cert
Cosmetology AAS
Criminal Justice AAS
Culinary Arts AAS
Customer Service Representative AAS
Dental Assisting AAS
Diagnostic Medical Sonography AAS
Diesel/Heavy Duty Equipment AAS
Echocardiography AAS
Effective Business Writing - Cert
Electrical Maint & Automation AAS
Electrical Trainee - Cert
Electrical Sales - Cert
Power Systems Maint AAS
Electronics Eng Tech AAS
Electronics Eng Tech - Avionics AAS
Electronics Eng Tech - Mechatronics AAS
Electronics Eng Tech - Cert
Electronics Engineering - Applications AAS
Emergency Medical Tech (ineligible for Financial Aid)
Esthetician - Cert
Expanded Function Dental Auxiliary - Cert
Fire Officer AAS
Fire Science Tech AAS
Front Office Prof - Cert
Greenhouse Nursery AAS
Greenhouse Nursery - Cert
Health Information Management (online only) AAS
Heating, Vent, Air Conditioning & Refrigeration AAS
Hospitality, Tourism, & Event Management - Cert
Hydraulic & Pneumatic Automation Tech AAS
Hydraulic & Pneumatic Automation Tech - Cert
Industrial and Manufacturing Technology - Cert (Colville
Campus only)
Integrated Business & Entrepreneurship - Cert
Invasive Cardio Vascular Tech AAS
Landscape Management AAS
Landscape Management - Cert
Legal Administration AAS
Legal Office Software Specialist
Legal Administrative Assistant AAS
Legal Clerical Assistant - Cert
Legal Receptionist - Cert
Machinist/CNC Tech (Day) AAS
Machinist/CNC Tech (PM) - Cert
Management AAS
Management - Cert
Manicurist - Cert
Marketing AAS
Mechanical Engineering Technology (MET) AAS
Mechanical Engineering Tech - Cert
Medical Assistant On-Campus AAS
Medical Assistant Online - Cert
Medical Clerical Assistant - Cert
Medical Office Billing & Coding Specialist AAS
Medical Office Receptionist - Cert
Medical Office Specialist AAS
Multi-Occupational Trades
Natural Resource Management AAS
Geographic Info Systems
Parks & Recreation AAS
Wildlife/Fisheries AAS
Network Design & Administration AAS
Cisco Networking - Cert
Microsoft Networking - Cert
Mobile Device Management - Cert
Networking Essentials - Cert
Linux/Unix Networking
Nursing DTA/MRP
Nursing Assistant Certified
Paralegal AAS
Pharmacy Tech On-Campus AAS
Pharmacy Tech Online AAS
Radiology Tech AAS
Respiratory Care (see BAS Respiratory Care)
Small Farm Production AAS
Small Farm Production - Cert
Software Development AAS
Android Mobile Development
Computer Science - Cert
Frontend Developer
Full Stack Developer
IOS Mobile Development - Cert
Mobile Developer - Cert
Mobile Device Management - Cert
Mobile Health Info Tech - Cert
.Net Developer - Cert
PHP Developer
Web Design - Cert
Web Developer - Cert
Surgical Tech AAS
Truck Driver or CDL - Cert
Utility Construction Pre-apprenticeship (Gas or Line)
Vascular Tech AAS
Water & Wastewater AAS
Water Resources Technology AAS
Water Resources Technologies in GIS - Cert
Welding & Fabrication (Day) - Cert
Welding & Fabrication (PM) - Cert
FOR LIBERAL ARTS / GENERAL STUDIES OR TRANSFER DEGREE SEEKERS ONLY.
Please check the box next to the degree program in which you intend to enroll.
Associate in Arts DTA
Associate in Math Education DTA
Associate in Pre-Nursing
Associate in Science Track 1 Bio/Envr/Chem/Geol/Earth
Associate in Science Track 2
ENGR/CS/PHYS/ATMOS
Engineering: BIO/CHEM AS-T MRP
Engineering: Comp/Elect AS-T MRP
Engineering: Mech/Civil/Aero/Industrial/Other AS-T MRP
Biology DTA
Business DTA/MRP
Non-Degree Seeking
(ineligible for Financial Aid)
While attending SCC you can take classes that apply to the following SFCC programs
Hearing Instrument Specialist
Orthotic-Prosthetic Tech
Physical Therapist Assistant
SPOKANE FALLS COMMUNITY COLLEGE
Addiction Studies AAS
Addiction Studies - Cert
Administrative Assistant AAS
Office Assistant - Cert
Applied Management - BAS
Audio Engineering AAS
Audio Engineering - Cert
Business Management
Business Management - Cert
General Business AAS
Marketing AAS
Retail Management - Cert
Social Media – Cert
Small Business Mgmt AAS
Social Media AAS
Social Media Marketing - Cert
Business Tech/Software Specialist AAS
Bus & Software App - Cert
Computer Science & Inf. Tech AAS
Computer Forensics/Networks - Cert
Computer/Network Support - Cert
Comp. Science & Inf. Tech Cyber
Security AAS
Cyber Defender
Basic Cyber Defense - Cert
Intermediate Cyber Defense – Cert
Advanced Cyber Defense - Cert
Digital Media Production AAS-T
Digital Marketing Specialist AAS
Digital Marketing Specialist - Cert
Early Childhood Education AAS
Early Childhood Education AAS-T
Early Childhood Education - Cert
ECE - Administration - Cert
ECE Family Child Care – Cert
ECE General - Cert
ECE Infant Toddler Care - Cert
ECE School Age Care - Cert
ECE State - Cert
ECE State Initial - Cert
ECE Home Visitor/Family Engag - Cert
Education Paraeducator
Education Parapro - Cert
Early Childhood Education AAS
School Library Media Tech AAS
Special Education AAS
Graphic Design AAS
Graphic Design AAS-T
Health/Fitness Tech AAS
Hearing Instrument Specialist AAS
Information Systems & Tech - BAS
Integrated Community Service AAS
Interior Design AAS
Interior Design AAS-T
Interpreter Training AAS-T
Interpreter Training - Cert
Library & Information Svcs AAS
Library & Info Svcs - Cert
Occupational Therapy Assistant AAS
Orthotic/Prosthetic Tech AAS
Orthotics Tech - Cert
Prosthetic Tech - Cert
Photography AAS
Physical Therapist Assistant AAS
While attending SFCC you can take classes that apply to the following SCC programs
Accounting Assistant
Dental Assisting
Health Info Tech
Invasive Cardio Tech
Medical Assistant
Medical Lab Tech
Non-Degree Seeking
(ineligible for Financial Aid)
Nursing (Associate in) DTA/MRP
Pharmacy Tech
Radiology Tech
Respiratory Care
Surgical Tech
FOR LIBERAL ARTS / GENERAL STUDIES OR TRANSFER DEGREE SEEKERS ONLY.
Please check the box next to the degree program in which you intend to enroll.
Associate in Arts (DTA/MRP)
Associate in Biology (DTA)
Associate in Business (DTA/MRP)
Associate in Math Education (DTA)
Associate in Pre-Nursing (DTA)
Associate in Music (DTA)
Associate in Fine Arts
Arts
Drama
Music
Certificate in Fine Arts
2/D
3/D
Associate in Science Track 1
Associate in Science Track 2
Comp/Physics/ATM
Bio and Chemical
Computer/Electrical
Mech/Civil/Aero/Industrial
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Student Information Update Ccs 40-194 (Spokane Community College)

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Completed 27 July 2020

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