2010-2011 College Catalog - North Florida Community College

APPLICATION FOR ADMISSION
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ADMISSION APPLICATION FOR
NORTH FLORIDA COMMUNITY COLLEGE
325 NW Turner Davis Drive, Madison, Florida 32340
Contact NFCC Admissions for more information: 850/973‐1622 or 850/973‐9405 or email ADMISSIONS@NFCC.EDU. Fax 850/973‐1697
1 STUDENT NFCC ID NUMBER (If previously attended)
2 SOCIAL SECURITY NUMBER
G
3 LEGAL NAME
(LAST) (FIRST) (MIDDLE)
4 PRIOR NAME IF APPLICABLE (Maiden) 5 HAVE YOU PREVIOUSLY ATTENDED NFCC?
Yes
No*
6 MAILING ADDRESS *All first time Applications MUST include $20.00 Nonrefundable fee
7 PHONE NUMBERS
(Street) (APT #)
(City) (County) (State / Zip Code)
Home ‐
8 EMERGENCY CONTACT INFORMATION Work ‐
Name
Relationship to student Cell ‐
Phone:
THE FOLLOWING INFORMATION IS REQUIRED BY THE U.S. DEPARTMENT OF EDUCATION UNDER TITILE VI OF THE CIVIL RIGHTS ACT OF 1964 AND THE TITLE IX OF THE EDU‐
CATIONAL ADMENDMENTS OF 1972 TO BE USED FOR REPORTING PURPOSES AND IS NOT USED IN DETERMINING ADMISSIONS TO NORTH FLORIDA COMMUNITY COLLEGE.
9 SEX 11 CITIZENSHIP 12A ETHNICITY 13 RACE 14 COUNTRY OF CITIZENSHIP
Male U.S. Citizen Refugee Alien Are you Hispanic or Latino? American Indian or
Female F‐1 Student Other, Non‐citizen Yes No Alaskan Native
10 DATE OF BIRTH Visa Other Than F‐1 Visa type __________ 12B ETHNICITY Asian
15 WHAT IS YOUR PRIMARY
10A
____/_____/________
(Month/Day/Year
Permanent Resident Alien Asia or Pacific Islander Black or African American LANGUAGE?
COUNTRY OF BIRTH _____________________ Black (Not Hispanic) Hispanic (I.E. THE LANGUAGE YOU USE
PASSPORT, VISA AND/OR ALIEN CARD REQUIRED AT ADMISSIONS Hispanic
Native Hawaiian or other
MORE THAN 50% OF THE TIME)
City & State of Birth
American Indian or
Alaskan Native
White (Not Hispanic)
White
Pacific Islander
16 DEGREE OBJECTIVE 17 ENTERING YEAR 18 BASIS OF ADMISSION
ASSOCIATE IN ARTS ______________________________________ 20
ASSOCIATE IN SCIENCE ___________________________________ √ TERM
ASSOCIATE IN APPLIED SCIENCE ___________________________
FALL (AUGUST)
CREDIT CERTIFICATE ____________________________________
TECHNICAL DIPLOMA ____________________________________
VOCATIONAL CERTIFICATE ________________________________
SPRING (JANUARY)
SUMMER A (MAY)
HIGH SCHOOL GRAD/GED
UNIV/COLLEGE TRANSFER
TRANSIENT STUDENT
19 DID BOTH OF YOUR PARENTS EARN
A FOUR‐YEAR COLLEGE DEGREE?
SUMMER B (JUNE) YES NO
TRANSIENT STUDENT ____________________________________
20 ARE YOU A VETERAN? Discharge Date ___________________
EPI PROGRAM___________________________________________ YES NO Branch__________________________
21
NON‐DEGREE SEEKING JOB RELATED TRAINING SENIOR CITIZEN (Must be 65 or older & DOB must be verified)
PERSONAL GROWTH
EDUCATION BACKGROUND (APPLICANTS WITH SPECIAL DIPLOMAS MUST OBTAIN A GED DIPLOMA BEFORE APPLYING)
DATE RECEIVED/ANTICIPATED
STATE AND COUNTRY (IF NOT US)
HOME SCHOOLED (NOTARIZED AFFIDAVIT REQUIRED) ___________ / ___________ / ______________
GED DIPLOMA
___________ / ___________ / ______________
STANDARD HIGH SCHOOL DIPLOMA ___________ / ___________ / ______________
NAME OF HIGH SCHOOL
All college credit and most PSAV applicants must have a Standard or College‐ready high school diploma or GED certificate. Please have an official
transcript sent from the high school to NFCC Admissions. For GED completers, please provide a copy of the GED Certificate and an official copy of
the test scores.
2010-2011 NFCC College Catalog
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