THE VIEW – WINTER 2007 SCHEDULE - Olympic College

WINTER CREDIT CLASSES
APPLICATION FOR ADMISSION
PLEASE TYPE OR PRINT WITH A BALL POINT PEN
1600 Chester Avenue
Bremerton, WA 98337-1699
Social Security Number*
- -
Your intended Major area of study
SHADED AREAS FOR OFFICE USE ONLY
Have you ever applied or attended
classes for credit offered by this college?
Yes No If yes, when?_____
*Your social security number is confidential and, under a federal law
called the Family Educational Rights & Privacy Act, the College will
protect it from unauthorized use and/or disclosure. In compliance with
state/federal requirements, disclosure may be authorized for the purposes
of state and federal financial aid, Hope/Lifetime Learning tax credits,
academic transcripts, or accountability research. A College ID number
will be assigned for use in all future College transactions other than those
listed above.
Quarter you plan to start?
Fall Winter Spring
Summer Year ______
Do you plan to Sex
transfer to a four-year
Female
college?
Male
Yes No
Advisor Student ID Number Quarter Code Student Program Date Application
Date of Month Day Year
Rec’d
Birth: _________ / _____/ ______
Last Name First Name Middle List previous names
Address: number and street/P.O. Box
No
Apt.
1. _____________________________________________
2. _____________________________________________
City, State, ZIP Code
Which race do you consider yourself to be?
(This question is optional. The information is used for
statistical purposes only.)
American Indian or Alaska Native (597)
Black or African American (872)
Chinese (605)
Filipino (608)
Korean (612)
Vietnamese (619)
Japanese (611)
White (800)
Other Asian (621)
Native Hawaiian or Pacific Islander (653)
Other Race (799) (specify) _____________
Are you of Spanish or Hispanic origin?
No (999)
Yes, Mexican, Mexican American, Chicano (722)
Yes, Cuban (709)
Yes, Other Spanish/Hispanic/Latino
Specify: __________________
U.S. Citizen? Yes No
If not a U.S. citizen, country of citizenship
__________________________________
If not a U.S. citizen, what is your Visa status?
International Student (with F or M Visa)
Visitor
Temporary Resident
Alien No. _________________________
Immigrant/Permanent Resident
Alien No. __________________________
Refugee/Parolee or Conditional Entrant
Alien No. __________________________
Other Explain ______________________
Residency for tuition purposes:
1. Have you been a legal resident of Washington
and lived continuously in Washington for the
last 12 months? (A student cannot qualify as a
Email: Branch: Bremerton ____ Shelton _____
Poulsbo _____ Bangor/Naval Hosp _____
Day Telephone No.
( )
Evening Telephone No.
( )
(Residency, cont.)
legal resident of Washington for tuition calculation
purposes if s/he possesses a valid out-of-state driver’s
license, vehicle registration or other document that gives
evidence of being a legal resident in another state.)
___ Yes ___ No If no, how long have you lived
continuously in Washington? ___ months
2. Were you claimed for federal income tax purposes by
your mother, father, or legal guardian in the current
calendar year? __ Yes __ No.
In the past calendar year? __ Yes __ No
If YES, has your mother, father or legal guardian
lived continuously in Washington for the past 12 mos?
__ Yes __ No
3. Will you be attending college with financial aid
provided by a public or private non-federal agency
or institution outside of Washington where state
residency is a requirement for receiving that aid?
__ Yes __ No
4. Are you active duty military stationed in Washington?
__ Yes __ No. Are you the spouse or dependent
of an active duty military person stationed in
Washington? __ Yes __ No
Residency Code
Fee Pay Status
WINTER CREDIT CLASSES
GED test taken? Yes No
If yes, date earned _________________ Where? ____________________________
Pre-college tests taken: ASSET COMPASS
Year ______
Where ______________________________________
Name of last high school attended HS Code City and State Years attended
From To
Year______ Year _____
Name of last college, vocational/technical school attended Code City and State Years attended
From To
Year______ Year _____
Name of other college, vocational/technical school attended Code City and State Years attended
From To
Year______ Year _____
Name of other college, vocational/technical school attended Code City and State Years attended
From To
Year______ Year _____
List any additional colleges and vocational/technical schools on a separate sheet of paper and attach.
I certify to the best of my knowledge all statements on this form are true.
Graduated
Yes, Year ____
No, Highest
Grade completed ___
Graduated
Yes, Year ____
No
Graduated
Yes, Year ____
No
Graduated
Yes, Year ____
No
Print Name ____________________________________
Signature ______________________________________________________ Date________________________
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