hartnell college fall 2009

Semester/Yr: Entered by: Date:STEP 1Hartnell CollegeAPPLICATION FOR ADMISSION* Office of Admissions and Records * 156 Homestead Avenue * Salinas , CA 93901 * Telephone : (831) 755-6711 * Fax: (831) 759-6014PLEASE ANSWER ALL QUESTIONS AND PRINT CLEARLY. Incomplete applications cannot be processed.PLEASE USE BLACK OR BLUE INK PENS ONLYLEGAL NAME: Do not use nicknames Mr.Ms. Mrs. Dr.Last Name First Name Middle Name (Names previously used)PERMANENT MAILING ADDRESSP.O.Box/Number/Street/Apt.No. City/State Zip Code County or CountryArea CodeHome TelephoneNumberE-Mail AddressApply on line: www.hartnell.eduSOCIAL SECURITY NUMBER-- --BIRTHDATEMonth Day YearNOTE TO ALL STUDENTS: You are hereby informed that you cannot be required toprovide a Social Security Number (SSN). The SSN is used by colleges as a commonmethod to identify students records, and is authorized by the state chancellor's officeof California Community College system which uses them for evaluation of educationalprograms and services. If you refuse to provide a SSN, a local student I.D. numberwill be assigned. Students who do not have a Social Security Number on file will berequired to produce their local student I.D. number for all current and future services.Also Public Law 104-208 Known as the Solomon Amendment requires HartnellCollege to provide student directory information to the Department of Defense, including Militaryrecruiters, upon request. Dependents of service-connected disabled or service-connected deceasedveterans may be eligibile for a waiver of fees. Please contact the Veteran's Office on campus or localCounty Veteran Service Office for assistance.Ethnic Background (choose only one)(B.)(N.)(AM)(AC)(AJ)(AK)African/AmericanNative-American/AlaskanAsian/CambodianAsian/ChineseAsian/JapaneseAsian/Korean(AL)(AV)(AX)(F.)(HR)(HM)Asian/LaotianAsian/VietnameseAsian/OtherFilipinoHispanic/Cent.AmericanHispanic/Mex-American(HS)(HX)(O.)(PG)(PH)Hispanic/S.AmericanHispanic OtherOther Non-WhitePacific Islander/GuamPacific Islander/Hawaii(PS)(PX)(AI)(W.)(X.)Pacific Islander/SamoanPacific Islander/OtherAsian/IndianWhite/Non-HispanicDeclined to StateGender:MaleFemale ADMISSION FOR (check only 1 semester): Major/Academic ProgramFall 20(see back page for Code List)Spring 20Summer 20*Please enter appropriate code:Admit Status: (check one)(RTS) Returning Transfer Student(HS) High School Student(FT)First Time Student At Any College(RFS) Returning Former Student(K8)K-8 Student(TRAN) First Time Transfer Student to Hartnell(CT)Continuing StudentEducational Goal(Check one item which best identifies your goals)BWAABWOAAAAWOTNCCWObtain a bachelor's degree aftercompleting an associate's degreeObtain a bachelor's degree withoutcompleting an associate's degreeObtain a two-years associate's degreewithout transferMove from Noncredit coursework toCredit courseworkCitizenship (Immigration Status): (check one)(1) U.S. CitizenVAWOTVOCCTCARJOBUPJOB(2) Permanent Resident-INS# A Issue Date:(3) Temporary Resident-INS# A Issue Date:Obtain a two-year vocationaldegree without transferEarn a vocational certificatewithout transferDiscover/formulate careerinterest, plans, goalsPrepare for a new career(acquire job skills)Advance in current job/career(update job skills)(4) Refugee/Asylee(5) Student Visa F-1/M-1(6) Other Status(7) Visitor(8) Amnesty(Please complete both sides of form)LICEDDEVBSSKHSDIP4YEARUNDMaintain certificate or license(e.g. Nursing)Educational development(intellectual, cultural)Improve basic skill inEnglish, Reading or MathComplete credits for HighSchool diploma or GEDIs English your native language?Yes (EN)No, Spanish (SP)Other (OT)4-year College student who needs tomeet a 4-year College Rqmt.Undecided on Goal