Student Affairs Division

ADMISSIONS APPLICATION ADM ISSIONS

PER S O NA L D A T A

Social Security Number - - Major (“Instructional Program”) Special Entry Code (select codes from list of Majors on this Application of Major Codes and Special Codes) 1. Name ______First Middle Last 2. Current Address ______Street Adress City ______State ______Zip Code ______3. Birthdate ( month/day/year) ______/ ______/ ______4. E-mail Address ______5. Home Telephone ______- ______- ______Work Telephone ______- ______- ______6. In case of an emergency, call Name ______Relationship ______Home Telephone ______- ______- ______Work Telephone ______- ______- ______7. Gender M-Male F-Female 8. Racial/Ethnic Category (for statistics only). Colleges and universities are asked by many, including federal and state governments and national surveys to describe the racial and ethnic backgrounds of our students and employees. You should answer both questions. See Federal Definitions for Race on inside cover. Are you of Hispanic or Latino origin? 1-Yes 2-No What is your race? Select all that apply from the following categories. 1-African American or Black 2-American Indian or Alaska Native 3-Asian 5-White 7-Native Hawaiian or Other Pacific Islander 9. Have you been a Resident for 3 months or longer? Yes No 10. Permanent Residence 1- City 2-Maryland County Which county? (select code from list on back of this Application) 3-Out-of-State 4-International 5-Maryland DREAM ACT

11. U.S. Citizen? Yes No Country of citizenship ______12. If you are NOT a U.S. citzen, please indicate immigration status ______Documents verifying status must be presented at the time of application. Type of Visa 1-Refugee/Permanent Resident/Asylee, Alien Registration Number ______2-Student Visa 3-Other 4- Not applicable 13. Is English your principal language? Yes No 14. Military - 1-Active Duty 2-Veteran 3-Reservist 4-Dependent Are you applying for Veterans’ educational benefits? Yes No ENROLLM ENT D ATA

15. Admission Status New Student (A5) Attending BCCC for the first time and never attended another post secondary institution Transfer Student (A7)- Attending BCCC and previously attended another college/institution Returning Student (A8) Returning to BCCC as a credit student (attended as credit student more than one (1) ago) Attending Another College/Institution (A9) Attending BCCC and also attending another college/institution High School Sstudent (A10) Attending BCCC and also attending high school 16. Semester Applying for 1-Fall ______2-Spring ______3-Summer ______4-Winter ______17. Enrollment Status 1-Full-Time Student (12 credits) 2-Part-Time Student (1-11 credits) 18. Education Goal 01-Associate Degree 02-Certificate 03-Taking course to transfer (not seeking AA or certificate) 04-Taking course without working toward a degree or certificate 05-Other ______19. Which of the following goals do you hope to achieve from your studies at BCCC? (select all that apply) 1-Explore new career(s) 2-Prepare for immediate entry into a career 3-Prepare for transfer to a 4-year institution 4-Update skills for my current job 5-Pursue personal interest and self-enrichment 6-Other ______Continued on back ADMISSIONS

20. High School/GED 1-High School Diploma-Graduation Date ______2-MD High School Diploma (GED) Date ______High School Code (select code from list on this Application) Other (School Name/City/State/Country) ______21. List all colleges and universities attended, including BCCC, either full- or part-time. School Name Address From Mo./Yr. To Mo./Yr. Degree/Certificate Received ______/ ______/ ______/ ______/ ______/ ______/ ______/ ______/ ______

OtHer Data

22. Employment Status When you start classes, how many hours do you expect to be employed per week? (Enter “0” if you do not plan to be employed.) ___ hours per week 23. Has either of your parents received a Bachelor’s degree? Yes No 24. How did you hear about Baltimore City ? (check all that apply) 1-School Counselor 2- BCCC Admissions 3-BCCC Publication 4-Newspaper 5-Billboard 6-Radio 7-Television 8-Friend 9-Internet 10- Other______

Please read and sign the following: To the best of my knowledge, every statement I have made on this Admissions Application is correct. I ­realize that deliberately falsifying or omitting information could be grounds for dismissal from the College. I understand that it is my responsibility to notify the Admissions or ­Registrar’s Office of any changes in this informa- tion. I accept and agree to abide by all policies and regulations of BCCC including those concerning drug and alcohol abuse. I understand that the unlawful use of drugs or alcohol will subject me to the penalties contained in those policies and regulations.

The $10 non-refundable Application Fee accompanies this Application.­

Signature of Applicant ______Date ______

Admissions Office, 2901 Liberty Heights Avenue, Baltimore, Maryland 21215 Office: 410-462-8300 • Fax: 410-462-8345

5/16 ADM ISSIONS

MAJOR CODES AND SPECIAL CODES Majors Codes Computer Applications and Technology Legal Assistant (D) Associate degree program 180 Computer Aided Design (D) 067 Legal Assistant (D)** (C) Certificate program 021 Computer Information Systems (D) Allied Health 185 Fashion Design (D) Science Technology 186 Fashion Design (C) 100 General Studies - Interest in Dental Hygiene* 145 Biotechnology (D) 187 Fashion Design, Fashion Retailing (D) 119 General Studies - Interest in Health Information 404 Lab Animal Science (C) 714 Cyber Security and Assurance (D) Technology/Coding** 405 Biotechnology Lab Science (C) 710 Cyber Security and Assurance (C) 104 General Studies - Interest in Nursing* Teacher Preparation Engineering 217 General Studies - Interest in Practical Nursing* 256 Elementary Educ/Generic Spec Educ PreK-12 (D) 023 Engineering** 106 General Studies - Interest in Physical Therapist Assistant* 116 Special Education Assistant (C) 271 Electrical Engineering 219 General Studies - Interest in Respiratory Care* 260 Substitute Teacher (C) 307 Robotics 129 General Studies - Interest in Surgical Technology* 141 Teacher Education Math/Science 712 Paramedicine (D) Criminal Justice and Public Safety 019 Teacher Education Transfer (D) 713 Paramedic (C) 081 Correctional Administration (D) Special Entry Codes 711 Paramedic Bridge (C) 022 Law Enforcement (D) Arts and Sciences Transfer 189 Coppin Focus Early Childhood 622 English Language Institute 170 Art Option 051 Early Childhood Education (D) 078 High School/BCCC Early Enrollment 503 Mathematics Option 251 Early Childhood Administration (C) 089 Morgan Connect 603 Music Option General 614 Talent Search 507 Psychology Option 625 Teacher Certification Pathway 008 General Studies Transfer (D) 504 Science Option 613 Tech Prep 624 Non-degree/certificate- seeking student 606 Theatre Option 616 Upward Bound Business and Office Administration/Technology Human Services 624 Non-matriculating 127 Addiction Counseling (D) 001 Accounting (D) 128 Addiction Counseling (C) 211 Accounting (C) 125 Allied Human Services Transfer (D) 004 Business Administration Transfer (D) 048 Allied Human Services (C) 013 Business Management (D) 031 Mental Health Services (D) 055 Business Marketing (D) 400 Construction Supervision Program (D) 401 Construction Supervision (C) 259 Office Administration, Administrative Assistant (D) * Student must meet with Selective Admissions Counselor before enrolling in program. Code will be changed when prerequisites are met and confirmed. 709 Information Technology Basic Skills ** Student must meet with Program Coordinator before enrolling in program.

MARYLAND COUNTY CODES (Application item #10)

01 Allegany 04 Calvert 07 Cecil 10 Frederick 13 Howard 16 Prince George’s 19 Somerset 22 Wicomico 02 Anne Arundel 05 Caroline 08 Charles 11 Garrett 14 Kent 17 Queen Anne’s 20 Talbot 23 Worcester 03 Baltimore 06 Carroll 09 Dorchester 12 Harford 15 Montgomery 18 St. Mary’s 21 Washington 24 Baltimore City HIGH SCHOOL CODES (Application item #20) **H999 Out-of-Maryland Masonville Cove and Technology Middle/High 210143 Northwestern **H001 Central Career Center at Briscoe 210247 Bluford Drew Jemison STEM 210101 Harbor City High School 210160 Patterson **H888 GED (MD HS Diploma) Academy West 210135 Heritage 210170 Paul Laurence Dunbar **H000 No High School/GED 210060 Carver Voc-Tech 219501 Home Schooled 210178 Reginald F. Lewis School of **H099 Foreign High School 210052 City Neighbors High 210308 Independence School Business and Law 210202 Academy for College and Career 210569 ConneXions Community 210349 Institute of Business and 210194 REACH! The Partnership School Exploration Leadership Academy Middle/High Entrepreneurship High 210222 Renaissance Academy 210238 Augusta Fells Savage Institute of 210189 Coppin Academy 210195 KASA (Knowledge and Success 210210 Southern Visual Arts 210067 Digital Harbor High School Academy) Middle/High 210489 210051 Baltimore Antioch Diploma Plus 210204 Doris M. Johnson 210106 Lake Clifton/Eastern 210211 Southwestern 210035 210082 Edmondson Senior/Westside 210081 Laurence Paquin 210216 Thurgood Marshall High School 210049 Baltimore Civitas 210083 Fairmount/Harford Institute 210487 Maritime Academy 210218 Vivien T. Thomas Medical Arts 210048 Baltimore Freedom Academy 210085 Forest Park 210115 Mergenthaler Voc-Tech Academy 210485 Baltimore Liberation Diploma 210089 Francis M. Woods 210169 MD Academy of Technology and 210217 Waverly Career Center Plus High School 210075 Frederick Douglass Health Sciences Middle/High 210219 Walbrook High Uniform Services 210038 Baltimore Polytechnic Institute 210166 Friendship Academy of 210137 National Academy Foundation Academy 210044 Baltimore School for the Arts Engineering and Technology 210136 210068 W.E.B. DuBois 210199 Baltimore Talent Development Middle/High 210165 New Hope Academy 210220 Western 210193 Benjamin Franklin High at 210237 Friendship Academy of Science 210144 Northern 210223 William S. Baer School

ADMISSIONS/CALL CENTER: 410-462-8300 • MD TOLL-FREE: 1-888-203-1261 • TTY: 1-800-735-2258 • www.bccc.edu

ADMISSIONS

ACCREDITATIONS maintained. The Physical Therapist Assis- A DRUG-FREE CAMPUS Baltimore City Community College is tant Program is approved by The Commis- As an institution of higher education, accredited by the Middle States Association sion on Accreditation in Physical Therapy Baltimore City Community College is of Colleges and Schools, meets the standards Education/American Physical Therapy As- dedicated to providing quality education set by the Maryland Higher Education sociation (CAPTE/APTA). The Respiratory in a campus environment conducive to Commission, and is authorized to grant Care Program has achieved Provisional academic learning. The illegal or abusive use the Associate degree. BCCC is nationally Accreditation status as defined for new pro- of drugs or alcohol by any member of the accredited by the Association of Collegiate grams by the accreditation procedures of the College community jeopardizes the safety Business Schools and Programs (ACBSP) Committee on Accreditation for Respiratory of all and will not be tolerated. Baltimore for the offering of the following degree Care (CoARC). The Surgical Technology City Community College is committed to programs: Accounting, Business Administra- Program is approved by the Accreditation having campuses that are free of the illegal tion/Management/Marketing, Computer Review Committee on Education in Surgi- or abusive use of drugs and alcohol. To this Information Systems, Administrative cal Technology (ARC-ST) and accredited by end, every student is required to read A Assistant and Legal Administrative Assistant. the Commission on Accreditation of Allied Drug-Free Campus: A Student Guide, The Dental Hygiene Program is accred- Health Education Programs (CAAHEP), available in the Admissions Office, ited by the American Dental Association The American College of Surgeons, and Registrar’s Office, Student Life Office, Commission on Dental Accreditation. The The Association of Surgical Technologists. or by calling 410-462-8300. Health Information Technology Program is accredited by the American Health Informa- NON-DISCRIMINATION tion Management Association (AHIMA) Baltimore City Community College is com- within the Commission on mitted to a policy of eliminating unlawful Accreditation of Allied Health Education discrimination based on grounds of race, Programs (CAAHEP). The Nursing Pro- color, religion, creed, gender, sexual orienta- gram is on the list of approved schools of tion, marital status, age, ancestry or national nursing published by the Board of Nursing. origin, or disability in the administration of Full accreditation of the Associate Degree in any of its educational programs, services, or Nursing from the National League for Nurs- activities, or with respect to employment. ing Accrediting Commission (NLNAC) is

Liberty Campus 2901 Liberty Heights Avenue • Baltimore, MD 21215-7807 and 2600 Liberty Heights Avenue • Baltimore, MD 21215-7804 Harbor business and Continuing Education Center • 710 E. Lombard Street • Baltimore, MD 21202-4096 reisterstown Plaza Center • 6764A Reisterstown Road • Baltimore, MD 21215-2306 the Life Sciences institute at the University of Maryland bioPark • 801 West Baltimore Street • Baltimore, MD 21201-1109

www.bccc.edu 5/16