Printable Application for Admission - South Plains College

SOUTH PLAINS COLLEGE
APPLICATION FOR ADMISSION
Return to: Admissions and Records Office
South Plains College, 1401 S. College Ave., Levelland, TX 79336
PLEASE PRINT ALL INFORMATION • USE BLACK OR BLUE INK ONLY
THIS APPLICATION SHOULD NOT BE USED BY INTERNATIONAL STUDENTS
PERSONAL INFORMATION
1. Social Security Number: _____________________________________
2. Full Legal Name: ______________________________________________________________________________________________________________
(Last / Family Name) (First) (Middle) (Suffix: Jr., etc.)
3. Other Names That May Appear on Academic Records: ________________________________________________________________________________
4. Gender: Male Female
5. Date of Birth: __________________________________________________ Place of Birth: __________________________________________________
(Month) (Day) (Year) (City) (State) (Country)
6. Ethnic Origin: Please check one of the following:
Hispanic or Latino Origin
Not Hispanic or Latino Origin
Race: Select one or more codes which best describe your ethnic background. This information will be used for Federal and/or State reporting purposes only in
accordance with statutory law.
White Black, or African-American Asian
American Indian or Alaskan Native
Native Hawaiian or Other Pacific Islander
7. Are you a veteran of the U.S. Armed Forces Yes No
8. Student E-Mail Address: ________________________________________________________________________________________________________
(Your acceptance letter will be sent to the email address provided.)
9. Permanent Address: ____________________________________________________________________________________________________________
(P.O. Box #) (Street Address) (Apt. #)
City: ______________________________________ County: ____________________ State: ________ Zip: ___________ Country: __________________
Permanent Telephone: ( ) ____________________________________ Cell Phone: ( ) ____________________________________
How long have you resided at this address Years _________________________ Months ____________________________
10. Address while attending SPC (if different from permanent address): ______________________________________________________________________
(P.O. Box #) (Street Address) (Apt. #)
City: ______________________________________ County: ____________________ State: ________ Zip: ___________ Country: __________________
11. Emergency Contact Name: ____________________________________________ Contact Phone: ( ) _________________________________
ENROLLMENT INFORMATION
12. Where do you plan to enroll (Indicate Code Number from Below) ______________
1. Levelland Campus 3. Byron Martin ATC 5. High School Dual Credit 7. Online Classes Only
2. SPC Reese Center 4. SPC Plainview Center 6. TTU (SPAN/TTAP)
8. Other
13. When do you plan to enroll at SPC Year ______________ Fall Spring Summer I Summer II Interim
14. What is your classification: (Indicate Code Number from Below) _______________
1. Freshman (0–29 Semester Hours) 4. Previously Earned an Associate Degree
2. Sophomore (30 – 72 Semester Hours) 5. Previously Earned a Bachelor Degree
3. Unclassified (Over 72 Semester Hours)
15. Intended Major: _________________________________________________________________________ Major Code Number: ___________________
(Refer to the program list on page 4 of this application for program name and code.)
16. Educational Intent: (Indicate Code Number from Below) ____________________
1. Earn an Associate Degree
2. Earn a Certificate
4. Courses for Specific Job Skills (Note: Financial Aid Not Awarded)
5. Personal Enrichment (Note: Financial Aid Not Awarded)
3. Earn a Degree or Credit for Transfer
Application continues to page 2 and is not considered complete until all information is provided and is signed by the applicant.
SPC APPLICATION FOR ADMISSION • PAGE 1 OF 4

EDUCATIONAL INFORMATION
17. Did you graduate or will you graduate from high school prior to the term for which you are applying (official transcript must be submitted) YES NO
Anticipated graduation date or date you will graduate: MONTH ____ YEAR ____
High school name: _______________________________________________________________ Home Schooled YES NO
Grade level completed in high school: 9th 10th 11th 12th Plan to enroll as: Dual credit student or Early admission
City: ________________________________________ County: _____________________________________ State: ___________ Country:____________________
18. If you did not graduate from high school, did you complete a GED (official GED score must be submitted) YES NO
City and state where GED was earned: ____________________________________________________ Date Granted:___________________________________
19. To determine TEXAS Grant eligibility, will you graduate from a Texas public high school with the Recommended or Distinguished High School Diploma YES NO
20. Did you earn Career and Technical Education (CTE) Credit at your High School YES NO Have you earned dual credit while in high school YES NO
21.
List each college, university, or technical school attended in chronological order. (Include colleges where you earned dual credit.) Do not abbreviate. Include SPC if
applicable. Incomplete information constitutes falsification of records and will void this application (To complete application requirements, you must have an official
transcript sent to SPC from each institution).
Institution
City/State
1. __________________________________________________________ __________________________ ______________________ ____________
2. __________________________________________________________ __________________________ ______________________ ____________
3. __________________________________________________________ __________________________ ______________________ ____________
4. __________________________________________________________ __________________________ ______________________ ____________
Total College Hours Earned _________________________
Are you on suspension YES NO SEMESTER _________ YEAR _____ (If YES, please see Admission Requirements in the Current General Catalog.)
During your last semester at a Texas public institution, did you pay resident (in-state) or nonresident (out-of-state)
____ Resident (in state) ____ Nonresident (out of state) ____ Unknown
If you paid in-state tuition at your last institution, was it because you were classified as a resident or because you were a nonresident who recieved a waiver
____ Resident ____ Nonresident with a waiver ____ Unknown
TEXAS SUCCESS INITIATIVE (TSI)
First Year &Term Attended/
Last Year & Term Attended
Placement tests are not used for admissions purposes, but must be taken prior to enrollment in any college-level course, unless you are exempt from the test. For
Total Hours
Completed
22. Are you exempt from required testing YES NO If YES, are you exempt because of one of the following
ACT SAT TAKS Scores Earned an Associate Degree Earned Bachelor’s Degree
DD214 Honorable Discharge after 1990 Exempted by previous college/university Plan to enroll in TSI waived Certificate Program
23. Name of Placement Test Taken: _______________________________ MONTH __________ YEAR ___________ Where taken _____________________________
RESIDENCY INFORMATION
(Please answer all questions. Use N/A if the question does not apply to you.)
24. a.) Are you a U.S. citizen YES NO If YES, what state and county are you a resident _____________________________ Years _________ Months _________
If NO, what state or country are you a resident _________________________________________________________________________________________
b.) If you are NOT a citizen, do you hold Permanent Residence status (valid I-551) for the U.S. YES NO
If YES, date Permanent Resident Card* issued: __________/_______/_________ Number: __________________ *Submit a copy of both sides of the card.
(Month) (Day) (Year)
c.) If you are NOT a U.S. Citizen or Permanent Resident, are you a foreign national whose application for Permanent Resident Status has been preliminarily
reviewed YES NO (You should have received a fee/filling receipt or Notice of Action (I-797) from USCIS showing your I-485 has been
reveiwed and has not been rejected.)
d.) If you are not a U.S. Citizen or Permanent Resident or have no application pending with the USCIS, have you lived in Texas for three years preceding high school
graduation in Texas and lived part of the time while attending high school with a parent or court-appointed legal guardian YES NO
e.) Are you a foreign national here with a Visa or are you a Refugee, Asylee, Parolee or here under Temporary Protective Status
YES NO If yes, indicate which: ________________________________________
25. List your address or addresses for the last three years. Please DO NOT leave blank.
Street Address City State Country From (Month/Year) Thru (Month/Year)
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
26. List employers and employment dates for the last two years (full-time work only):
Employer: _________________________________ Location ___________________________ From____________________ Thru _______________________
Employer: _________________________________ Location ___________________________ From____________________ Thru _______________________
Application continues to page 3 and is not considered complete until all information is provided and is signed by the applicant.
SPC APPLICATION FOR ADMISSION • PAGE 2 OF 4

27.
Are you claimed as a dependent or are you eligible to be claimed as a dependent by a parent or court-appointed legal guardian (To be eligible to be claimed as a
dependent, your parent or court-appointed legal guardian must provide at least one-half of your support. A step-parent does not qualify as a parent if he/she has not
adopted the student. YES NO If you checked YES, answer question 28. If you checked NO, answer question 29.
28. If your parent or court-appointed legal guardian will claim you as a dependent for the current tax year, please answer the following (Court-appointed legal guardian copies
of guardianship papers must be provided):
a.) Name of person who will claim you as their dependent: _______________________________________________________________________________________
b.) Relationship to self: Parent Legal Guardian Other Explain: ________________________________________________________________________
c.) Permanent address of this person (Street Address, City, State, Zip) ______________________________________________________________________________
How long have they resided at this address YEARS ________ MONTHS ________
d.) How long has this person resided in Texas YEARS ________ MONTHS _________ County of Residence: __________
e.) Previous State or Country of residence: _____________________________________________ YEARS ________ MONTHS _________
f.) If this person moved here within the past five years, why did this person move to Texas
Go to College Work Assignment Military Assignment Establish/Maintain a Home
Other (explain)_____________________________________________________________________________________________________________________
g.) Is this person a U.S. Citizen YES NO If NO, does this person hold a valid I-551 (Resident Alien) card YES NO
(If YES, a copy of both sides of the card must be provided.)
h.) Is your parent or court-appointed legal guardian currently on active military duty assignment in Texas
YES NO (If YES, documentation must be provided.)
i.) What state is the home of record with the U.S. Military for your parent or court-appointed legal guardian_________________ YEARS________MONTHS ________
If TX, how long has TX been listed as their military legal residence for tax purposes YEARS _________ MONTHS __________
j.) If this person was military assigned in Texas, is their intent to establish residence in Texas YES NO (If YES, provide “Intent to Establish Residence in Texas” form.)
29. If you file your own federal income tax as an independent tax payer, or file a joint return with your spouse, please provide the following information. (An independent tax
payer is not claimed as a dependent for tax purposes by another person.)
a.) How long have you lived in Texas YEARS _________ MONTHS________Legal County of Residence: _______________ YEARS _________ MONTHS ________
b.) Previous State or Country of residence: _________________________________________ YEARS _________ MONTHS _________
c.) If you moved here within the past five years, why did you move to Texas Go to College Work Assignment Military Assignment
Establish/Maintain a Home Other (explain) _________________________________________________________________________________________
d.) Are you currently on active military duty assignment in Texas YES NO (If YES, provide proof.)
e.) What state is your home of record with the U. S. Military ___________
If TX, how long has TX been listed as your military legal residence for tax purposes YEARS _________ MONTHS __________
f.) If you were military assigned in Texas, is your intent to establish residence in Texas YES NO (If YES, provide “Intent to Establish Residence in Texas” form.)
30. Is there any additional information that you believe your college should know in evaluating your eligibility to be classified as a resident If so, please attach additional
information with your application for admission.
OPTIONAL INFORMATION
31. Please indicate the highest level of your parents’ or court-appointed legal guardian’s educational background.
(This information is voluntary and is used in the general sense to help the college apply and qualify for Federal and State grants and other program.)
Father/Legal Guardian: No High School Some High School High School Diploma or GED
Some College Bachelor’s Degree Graduate/Professional Degree
Mother/Legal Guardian: No High School Some High School High School Diploma or GED
Some College Bachelor’s Degree Graduate/Professional Degree
CERTIFICATION OF RESIDENCY AND APPLICATION
32. I certify that this information is complete and correct to the best of my knowledge. I authorize the college to verify the information I have provided. I agree to notify the
proper officials of the institution of any changes in the information provided. I further understand that the officials will rely upon this information in determining my admission
and residence status for tuition purposes and that the submission of false information is grounds for rejection of my application, withdrawal of an offer for acceptance,
cancellation of enrollment, and/or disciplinary action. I also authorize South Plains College to electronically access my records regarding the Texas Success Initiative. I
understand that an official transcript must be received in a sealed envelope or sent directly by each institution in which I have previously enrolled to reach the Admissions
and Records Office no later that two weeks prior to enrollment at South Plains College. I acknowledge that I have access to the SPC safety information concerning bacterial
meningitis. If my application is accepted, I agree to abide by the letter and the spirit of all policies, rules and regulations of South Plains College.
Incomplete or illegible information will result in process delays. Please ensure that all requested and applicable information is listed. Application should be signed and dated.
Student’s Signature: ___________________________________________________________
Date: ______________________________________________________
Print Name: ___________________________________________________________________ Social Security Number: _____________________________________
South Plains College strives to accommodate the individual needs of all students in order to enhance their opportunities for success in the context of a comprehensive
community college setting. It is the policy of South Plains College to offer all educational and employment opportunities without regard to race, color, national origin, religion,
gender, disability or age.
SPC APPLICATION FOR ADMISSION • PAGE 3 OF 4

MAJOR PROGRAMS OF STUDY
ARTS AND SCIENCES TRANSFER OPTIONS
The suggested transfer options listed below are designed for students who plan to attend a university after leaving South Plains College.
These suggested transfer options lead to an Associate of Arts (A.A.), Associate of Science (A.S.), or Associate of Arts in Teaching (A.A.T.) degree.
CODE
0600
0101
3017
1002
0829
0401
0605
0506
1905
0704
3027
0103
1501
1101
4901
1914
2207
2205
1301
1701
1005
0835
PROGRAM
Advertising
Agriculture
Agricultural Communications
Art
AA in Teaching (Education)
Biology
Broadcast Journalism
Business Administration
Chemistry
Computer Science
Corporate-Organizational Communications
Criminal Justice
English
Foreign Language
General Studies (Academic Undecided)
Geology
Government
History
Human Sciences
Mathematics
Music Education/Performance
Physical Education
DEGREE
A.A.
A.S.
A.S.
A.A.
A.A.T.
A.S.
A.A.
A.S.
A.S.
A.S.
A.A.
A.A.
A.A.
A.A.
A.A. or A.S.
A.S.
A.A.
A.A.
A.S.
A.S.
A.A.
A.S.
CODE PROGRAM DEGREE
0301 Pre-Chiropractic A.S.
1204 Pre-Dentistry A.S.
0901 Pre-Engineering A.S.
1223 Pre-Medical Technology A.S.
1206 Pre-Medicine A.S.
1203 Pre-Nursing (B.S.N. Preparation) A.S.
1208 Pre-Occupational Therapy A.S.
1209 Pre-Optometry A.S.
1211 Pre-Pharmacy A.S.
1212 Pre-Physical Therapy A.S.
1213 Pre-Physician’s Assistant A.S.
1218 Pre-Veterinary Medicine A.S.
0601 Photojournalism A.A.
0602 Print Journalism A.A.
2001 Psychology A.A.
0604 Public Relations A.A.
0603 Radio, Television and Film A.A.
2208 Sociology A.A.
1506 Speech Communication A.A.
0904 Sports Broadcasting A.A.
1507 Theatre Arts A.A.
0107 Wildlife Management A.S.
TECHNICAL EDUCATION AND HEALTH OCCUPATIONS PROGRAMS
The technical programs below are designed for students with specific career goals. Courses are generally nontransferable; however, there are some colleges
where these credits may be accepted. These programs lead to an Associate of Applied Arts (A.A.A.) degree, Associate of Applied Science (A.A.S.)
degree and/or a Certificate of Proficiency (Cert.)
CODE TECHNICAL PROGRAM DEGREE
5821 Accounting Associate A.A.S.
5821C Accounting Certificate Cert.
8029 Applied Rehabilitation Psychology A.A.S.
8021 Associate Degree Nursing (ADN) A.A.S.
8022 ADN Advanced Placement Program A.A.S.
6424 Auto Collision Repair A.A.S.
6420C Auto Collision Repair Advanced Skills Cert.
6421C Auto Collision Repair Basic Skills Cert.
6422 Automotive Technology A.A.S.
6302C Automotive Technology - Advanced Cert. Cert.
6301C Automotive Technology - Basic Cert. Cert.
6524C Automoive Tech. Prep Enhanced Skills Cert.
6525C Automotive Tech. Svc. Parts & Sales Consultant Cert.
5621 Business A.A.S.
5621C Business Management Certificate Cert.
5222 Child Development A.A.S.
5222C Child Dev., Early Childhood Cert.
5220C Child Dev., Early Childhood Administrator Cert.
5223C Child Dev., Family Advocate Cert.
8448 Commercial Music A.A.A.
8449C Commercial Music Entertainment Business Cert.
8448C Commercial Music Performance Track Cert.
8450C Commercial Music Performance Track Adv. Cert.
6021 Computer Information Systems (CIS) A.A.S.
7106C CIS Digital Forensics Certificate Cert.
6021C CIS Programming Certificate Cert.
6022C CIS Networking Certificate Cert.
6023C CIS Technician Certificate Cert.
6227C Cosmetology Cert.
6228C Cosmetology Instructor Cert.
6224 Design Communications A.A.S.
6223C Design Communications Advanced Graphics Cert. Cert.
6222C Design Communications Software Skills Cert. Cert.
6423 Diesel Service Technology (DST) A.A.S.
6423C Diesel Service Technology Cert.
6425C DST Auxiliary and Drive Systems Cert.
6424C DST Diesel Engine and Controls Cert.
6231 Electrical and Power Transmission Technology A.A.S.
8020 Emergency Medical Services (EMS) A.A.S.
8022C EMT-Intermediate Cert.
8023C EMT-Paramedic Cert.
6231C EPT Electrical Technician Certificate Cert.
6232C EPT Basic Electrical Certificate Cert.
CODE TECHNICAL PROGRAM DEGREE
6821C Fire Academy Cert.
6822C Fire and Arson Investigator (Basic) Cert.
6823C Fire Inspector (Basic) Cert.
6824C Fire Officer I and II Cert.
6821 Fire Technology A.A.S.
5822C General Business Certificate Cert.
7020C HART Commercial Refrigeration AC Tech. Cert.
7221 HART Heating, AC & Refrigeration A.A.S.
7221C HART Residential AC Installation Tech. Cert.
6991 Industrial Manufacturing/Emerging Technologies A.A.S.
6991C Industrial Manufacturing/Emerging Technologies Cert.
6992C Industrial Manufacturing/Emerging Tech. Adv. Cert.
7021C Law Enforcement Police Academy Cert.
7021 Law Enforcement Technology A.A.S.
7022C Law Enforcement Enhanced Skills Certificate Cert.
5824 Office Technology A.A.S.
5824C Office Technology Certificate Cert.
6023C Office Technology Microcomputing Cert.
5828C Paralegal Certificate Cert.
5828 Paralegal Studies A.A.S.
5108 Physical Therapist Assistant A.A.S.
8033 Radiologic Technology A.A.S.
5423 Real Estate A.A.S.
5423C Real Estate Salesmanship Cert.
5423MSA Real Estate Salesperson Marketable Skill Cert.
8025 Respiratory Care A.A.S.
8434C Sound Reinforcement Certificate Cert.
8434 Sound Technology A.A.S.
8433C Sound Technology Enhanced Skills Certificate Cert.
8030 Surgical Technology A.A.S.
8031C Surgical Technology Certificate Cert.
8622 Technical Graphics & Design A.A.S.
8630C Technical Graphics & Design Adv. CAD Cert. Cert.
8622C Technical Graphics & Design Basic CAD Cert.
8445 Video Production Technology A.A.S.
8445C Video Production Technology Certificate Cert.
8447C Video Production Technology Advanvced Cert. Cert.
7821C Vocational Nursing Cert.
6245 Welding Technology A.A.S.
6245C Welding Technology Advanced Welding Proc. Cert.
6246C Welding Technology Basic Welding Proc. Cert.
SPC APPLICATION FOR ADMISSION • PAGE 4 OF 4 Rev. 06/13