OFFICE OF ENROLLMENT MANAGEMENT CECIL COLLEGE ADMISSIONS APPLICATION ONE SEAHAWK DRIVE Phone: (410) 287-1006 NORTH EAST, MD 21901 Fax: (410) 287-1001 www.cecil.edu Office Use Only Student ID#: ______Processed by: ______Date: ______
Complete this application for admission only. Upon registration, contact the Records & Registration Office (443-674-1600) to change any information.
1. Name: Last Name First Name
Middle Name ( Jr., Sr., III) Prior/Other Last Name
2. Email Address:
3. Permanent Home Address: (A P.O. Box is not accepted as a permanent address.)
Number and Street (and Apt. #) P.O. Box
City State Zip Code 4. Resident of: Cecil County Kent County Harford County Other MD County Out of State
Have you lived at this residence for three (3) months or longer? Yes No If no, date of Cecil Co. residency _ _/_ _/_ _ _ _
5. Telephone Numbers: - - - - Home Work
- - Cell
6. Date of Birth: - - 7. Gender: Male Female m m d d y y y y
8. Social Security Number: - -
9. Military Service: (Select one box or leave blank if this question does not apply to you) Veteran Active Duty Spouse or dependent of veteran/active duty Reserve Duty
10. Ethnicity: (Select one) Ethnicity/Race questions are used by the U.S. Department of Education. The information is collected solely for administrative purposes. Ethnicity/Race definitions are provided with the application.
Hispanic/Latino Not Hispanic/Latino
Please complete reverse side.
11. Race: (You may select more than one category) American Indian or Alaska Native Black or African American White Indian/Alaskan Native Asian Native Hawaiian or Other Pacific Islander
12. Citizenship Status: (Select one) U.S. Citizenship and Immigrant Service definitions are included in application.
United States Citizen Perman ent Resident Non- Resident Alien (Foreign) R eside R esident (If you selected Non-Resident Alien or Permanent Resident,nt call 443-674-1892 for verification purposes and to proceed with admission.)
13. Country of Citizenship: ______Type of Visa: (If you are a non-U.S. Citizen)
14. Calendar year and term you plan to attend Cecil College:
Year: Term: Fall Spring Summer :: 15. Degree or Certificate of Study: (List included in application)
2nd Degree or Certificate of Study: (Optional)
16. Current or most recent high school attended: North East High School Bohemia Manor High School Perryville High School Tri-State Christian Academy Rising Sun High School Elkton High School Tome School Home Schooled West Nottingham Academy
Lighthouse Academy Other Maryland High School Name GED: Maryland Out of State High School Name
GED: Out of State State
17. High school or GED graduation date: (Use the 15th if you do not know the date of your graduation)
- - m m d d y y y y
18. Please review your responses, read the statement below, and affix your signature and date.
I certify the information on this application is true and complete. I understand it is my responsibility to notify the Records and Registration Department of any change to the application information.
I accept and agree to abide by the policies and regulations of Cecil College as presently in effect and/or hereafter enacted. I understand the unlawful use of drugs and alcohol will subject me to the penalties contained in the policies and regulations. College policies are available at www.cecil.edu and in the College catalog.
Student Signature Date
Signature of Parent/Legal Guardian Date As the parent/legal guardian of a student under the age of 18 years by the first day of the student's enrollment, I hereby approve this application.
Revised 3/2017
ECA Student Questionnaire- This form allows us to get to know you as you apply to the Early College Academy. This form should be completed by the student. Student Information
Full Name: Date: Last First M.I.
Address: Street Address Apartment/Unit #
City State ZIP Code
Phone: Email
Primary Parent/Guardian Information
Full Name: Date: Last First M.I.
Address: Street Address Apartment/Unit #
City State ZIP Code
Phone: Email
Student Education
Middle School: Address:
From: To:
Middle School: Address:
From: To:
Favorite Hobbies Please list a few of your favorite hobbies: (Note: it is okay not to answer this question.):
Hobby 1:
1 1/29/2018
Hobby 2:
Hobby 3:
High School Interests Please select any of the following high school initiatives that interest you (Note: it is okay not to answer this question.): YES YES Academic Competition Team Marching Band and Color Guard YES YES Art Club National English Honor Society YES YES Athletics (Sports Teams) National Honor Society YES YES Chess Club Newspaper YES YES Chorus and Choral Ensemble Photography Club YES YES Class Advisors Project Lead the Way YES YES Concert Band Renaissance Committee YES YES Drama Department Robotics Club YES YES Envirothon Ski & Snowboard Club YES YES French Honor Society/French Club Spanish Honor Society YES YES Future Business Leaders of America Student Athletic Trainer YES YES Future Farms of America Student Council YES YES Gay/Straight Alliance Student Diversity Club YES YES Helping Hands Technical College High School (TCHS) YES YES Interact Club Tri-M Music Honor Society YES YES LEOs Club WOHS YES YES Library Book Club Yearbook
Top Three Colleges or Universities of Choice Please list three college or universities that you feel are a good fit for you and your educational goals (Note: it is okay not to answer this question.):
College/University: Desired field of study: College/University: Desired field of study: College/University: Desired field of study:
Signature
Signature: Date:
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Cecil County Public High School Early College Academy Application Process Enrollment for the 2018-2019 School Year
The following are instructions to help you complete the application:
1. Read the instructions carefully. 2. Students should complete the application in black or blue ink. 3. Return your completed application directly to your middle school counselor.
Step 1- Applying
Submit the following documents by April 1st, 2018 to your middle school counselor. Incomplete or late applications will not be considered.