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APPLICANT INFORMATION
Applicant Name
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Please enter your name as you wish it to appear on your records.
Last name:
First name:
Middle initial:
Suffix:
Name on previous academicrecords:
Last name:
First name:
Social Security Number
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Your Social Security number is necessary for the purposes of financial aid processing, Hope Scholarship Tax Credit, LifelongLearning Credit, and for verifying your completed courses should you request that your records be forwarded to an employer or to another college/university in the future. All Social Security numbers, as wellas the other information provided through the student application process, remain strictly confidential. Your Social Security number is provided one time. You will be given an ID and password to usethereafter. If you do not have a Social Security number or do not want to provide one, leave this field blank. However, failure to provide your Social Security number will result in a delay inprocessing your application. In addition, you will not be able to obtain your ID number and password until you come in to the Admissions and Records office and show a picture ID.
Social Securitynumber: ###-##-####
Please confirm Social Security number: ###-##-####
Personal Information
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Gender:
This information is requested to conduct research for institutional planning and to meet stateand federal reporting requirements.
Citizenship status:
If you selected Temporary Resident or Student Visa above, please select a visa type:

Select your country of citizenship (the country onyour passport):

Enter your Permanent/Temporary Resident, Refugee/Asylee, or Visa number:

Enter the issue date for the number above: mm/dd/yyyy
Date of birth: mm/dd/yyyy
This information is neededto comply with state and federal laws pertaining to residency, guardianship, and enrollment of minors in college.
Primary language:
Race/Ethnicity
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Per U.S. Dept. of Education...