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About SSL Certificates

Online Admissions Form

* = Required field

Student Information

Name*

Last


First


Middle


Previous Name(s)

Social Security Number*
Gender

Telephone

Home


Work


Cell


Permanent Address*

Number and Street, Rural Route, or Box Number


City

State

Zip


County


Prior Address (required if you've lived fewer than three months at your current address)

Number and Street, Rural Route, or Box Number


City

State

Zip


Email Address

(Official email from offices such as Admissions and Financial Aid will be sent to this address. Please submit a valid address.)


Date of Birth*
//
Month / Day / Year
Emergency Contact

Name


Telephone

 

Prior Education

Please check one:
High School GED Home School


Name of High School or GED site*

City

State
/
Completion Month/Year


Colleges or Universities Attended
Name of School

City - State

From

To

Academic Standing Upon Leaving


Name of School

City - State

From

To

Academic Standing Upon Leaving


Name of School

City - State

From

To

Academic Standing Upon Leaving


Highest Level of Education Completed


Have either of your parents completed a 4-year Bachelor Degree?
Yes No

Have you ever been a part of a TRiO program?
Upward Bound Educational Talent Search Other N/A


Student Type
New Student - Never attended college after high school graduation, includes high school students who only took dual credit.
Adult Ed - NOT ON PAPER APP
Readmit - JWCC is the ONLY college I have previously been enrolled in
Transfer - I have attended another college or university and will be transferring into JWCC
Summer Visitor Only - I do not plan on receiving a degree or using financial aid at JWCC - I will be transferring these credits
GED Preparation - This application will be forwarded to the GED Preparation Office.

 

Enrollment Plans

Reason for Enrolling
Term Applying For
Year

Enrollment Hours
Attendance Status

Attendance Goals
Transfer Plans


Major

Select the code that matches your major from the Program Code Chart


Please check if you are the following:
Online students only (I plan to complete my degree online - I will not attend the physical campuses of JWCC.)

Racial and Ethnic Survey (optional)

The information in this section is for required federal and state reports and is not considered when determining eligibility for any program. Although responses are voluntary, your assistance is greatly appreciated.

Employment status
Please identify your primary racial/ethnic group of the following racial groups:
Are you Hispanic or Latino (OR are you of Spanish origin)?
Are you from one or more of the following racial groups? (select all that apply) Asian American Indian or Alaska Native Black or African American White Native Hawaiian or Other Pacific Islander Choose not to respond/Unknown

Mandatory Question (must respond)

Are you in the United States on a Visa?*
No, I am a citizen of the United States.
No, I am not a citizen of the United States, but I am a legally registered alien or refugee.
*Resident number:
Yes, I am in the United States on a Visa.
Country of Origin
Visa Type
I am applying as a foreign student and wish to be considered for an F-1 visa.
Country of Origin


I hereby certify that, to the best of my knowledge, the foregoing information is true and complete, without evasion or misrepresentation.  I understand that if it is later found to be otherwise, it is sufficient cause for rejection or dismissal.



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