Admissions Application - Northwest Mississippi Community College

Application for admission
Registrar’s office
4975 Hwy 51 north
P.O. Box 7047
Senatobia, ms 38668
Social Security Number: _______ - _____ - _________
Phone Number: ( ) - _________ - _____________
E-mail: _____________________________________________________@________________________________________
*Non-degree seeking students are not eligible for financial aid.
Intended Major: __________________________ Major Code: _____________ Degree Seeking / Non-degree Seeking*
(See reverse for codes)
(mark one)
Campus you plan to attend:
Personal information Senatobia DeSoto Oxford Online Ashland
Name:________________________________________________________________________________________________
Last First Middle Maiden
Physical Address:______________________________________________________________________________________
Street City State Zip County
Mailing Address: ______________________________________________________________________________________
if different from physical Street or P.O. Box City State Zip County
Date of Birth: ___/___/____ City/State/Country of Birth: _______________________ MS Resident?
Gender:
Race/Ethnicity: Are you Hispanic/Latino?
Yes No
Male Female
Yes No
U.S.Citizen?
What is your race? (You may choose more than one) ___White ___ Black or African American
Yes No ___ Asian ___ American Indian or Alaska Native ___ Native Hawaiian or Other Pacific Islander
Family Information
**If you choose guardian, you must mail in official guardianship documents.
Choose One: ___ Parent ___ Guardian** ___Spouse Name: ______________________________________________
Last
First
Mailing Address: ___________________________________________________________________________________
Street or P.O. Box City State Zip
High School information If any of your transcripts are from out of state, you must provide proof of residency.
Official high school transcript or GED and ACT scores (see NWCC catalog for exceptions) are required for admission to be complete.
High School: _________________________________________________________ Graduation Date: ___________________
Location: ___________________________________
(Month/year)
GED Information
City
State
Do you have a GED diploma?
If yes, graduation date: _________ State where GED was completed: _______
Yes No
(Month/Year)
College Information
All official college transcripts are required for admission to be complete.
Have you ever attended NWCC?
Name at time attended: __________________________________________
Last
First
Yes No
Dates attended: _____________________
List all colleges previously attended:
Failure to list complete and accurate information could result in the cancellation of your enrollment.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
What semester do you plan to attend NWCC? ___ Fall ___Spring ___ Summer What year? _____________________
Applicant’s signature: ________________________________________________________________________________ date: _______________________
I certify the information I have provided on this application is accurate and that I have not intentionally withheld information requested.
I further understand that falsification of information is a basis for denying admission or for immediate termination of enrollment. My
signature above also authorizes the release of my transcripts from all schools previously attended to Northwest’s Registrar’s office.
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ASSOCIATE OF ARTS DEGREE
205 Accountancy
120 Animal Science
405 Art
704 Biology
220 Business & Computer Teacher
Education
218 Business Administration
708 Chemistry
416 Communications/Public
Relations
410 Communications/Broadcasting
415 Communications/Journalism
213 Computer/Management
Information Systems
712 Computer Science
515 Criminal Justice
305 Elementary Education
345 Exercise Science
130 Forestry
510 General College Curriculum
105 General Agriculture
ASSOCIATE OF APPLIED SCIENCE
6005 Accounting Technology
6022 Agricultural Business & Mgmt
Tech/Animal Husbandry
6010 Agricultural Tech/John Deere
Tech
8014 Automotive Technology
8014 Automotive Tech/Chrysler
College Auto Program
6012 Aviation Maintenance Tech
6045 Business & Marketing
Management Tech
6098 Cardiovascular Technology
6030 Civil Engineering Technology
6032 Civil Engineering Tech/Pre-
Surveying/Geomatics MSU
CODES FOR MAJORS
724 General Science
340 Health & Physical Education
505 Liberal Arts
417 Marketing Communications/PR
Mgmt
784 Mathematics
420 Music, Music Education, Music
Performance
423 Music Business/Industry
605 Nursing (Associate Degree)
240 Office Administration
131 Outdoor Recreation & Mgmt
788 Physics
720 Pre-Architecture
744 Pre-Clinical Laboratory Sciences
347 Pre-Communicative Disorders
730 Pre-Cytotechnology
732 Pre-Dental
734 Pre-Dental Hygiene
716 Pre-Engineering
710 Pre-Forensic Chemistry
6052 Drafting & Design Engineering
Tech/Arch Eng
6050 Drafting & Design Engineering
Tech/ Gen Drafting
6025 Early Childhood Education
Technology
6070 EMT-Paramedic
6085 Funeral Service Technology
6035 Graphic Design Technology
6079 Health-Care Data Technology
8015 Heating, Air Conditioning &
Refrigeration Tech
6065 Hotel & Restaurant Mgmt Tech
6056 Industrial Electronics
Engineering Tech
127 Pre-Health Information
Management
742 Pre-Health Sciences
726 Pre-Horticulture
718 Pre-Landscape Architecture
722 Pre-Landscape Contracting
736 Pre-Medical
748 Pre-Nursing (BSN)
752 Pre-Occupational Therapy
738 Pre-Optometry
756 Pre-Pharmacy
760 Pre-Physical Therapy
764 Pre-Radiological Sciences
768 Pre-Veterinary Medicine
770 Pre-Veterinary Medical Technology
520 Psychology
342 Recreation
307 Secondary Education
535 Social Work
425 Theatre
6038 Information Systems Tech/
Computer Networking
6041 Information Systems Tech/
Computer Programming
6009 Microcomputer Technology
6014 Office Systems Technology
6090 Paralegal Technology
6099 Paralegal Tech/Pre-Paralegal
Studies UM 2+2 Option
6093 Respiratory Therapy
6092 Surgical Technology
7005 Precision Manufacturing and
Machining Technology
CAREER CERTIFICATE
6031 Civil Engineering Technology
(One-Yr Certificate)
8005 Collision Repair Technology
8075 Commercial Truck Driving
8035 Cosmetology
8036 Cosmetology/Nail Technician
Option
6071 EMT-Basic
8062 Health Care Assistant
6013 Office Systems Technology (One-
Yr Certificate)
8060 Practical Nursing
8070 Welding And Cutting
AFFIRMATIVE ACTION—Northwest Mississippi Community College does not discriminate on the basis of race, color, national origin, sex, religion, age, disability
or status as a veteran or disabled veteran in employment, programs, or provision of services. Compliance with Section 504 of the Rehabilitation
Act of 1973 and the Americans with Disabilities Act is coordinated by Mr. Michael Dottorey, Disability Support Services Coordinator, McLendon Student
Center, P.O. Box 5555, Highway 51 North, Senatobia, Mississippi 38668, telephone number 662-562-3309, email address mldottorey@northwestms.
edu. Compliance with Title II of the Age Discrimination Act and Title IX of the Education Amendments of 1972 is coordinated by Mr. Gary Mosley, Vice
President for Fiscal Affairs, James P. McCormick Administration Building, P.O. Box 7017, 4975 Highway 51 North, Senatobia, Mississippi, 38668, telephone
number 662-562-3216, email address gtmosley@northwestms.edu.