OFFICE USE ONLY NAME San Jose/Evergreen Community College District APPLICATION FOR ADMISSION Colleague ID # LAST Term & College for which you are applying: FALL SPRING SUMMER 20 Date Check ONE college only Evergreen Valley College San José City College Initials If you plan on taking classes at BOTH colleges within this District, make sure you have a current application AT EACH COLLEGE 1 Legal Name Last Name First Name Middle Initial 2 Address Number & Street Apt. Number FIRST City State Zip Code 3 Telephone Number Home Other 4 Origin Walk-In Mail 5 Social Security Number 6 Birth Date (Necessary for Financial Aid applicants) MM DD YY Returning Student’s / ID # 7 Ethnic Background AL Asian/Laotian HCA Hispanic/Central America PACG Pac Islander/Guam A Asian AM Asian/Cambodian HM His/Mex Hisp/Amer PACH Pac Islander/Hawaiian AA African/American AV Asian/Vietnamese HSA Hispanic/South America PACS Pac Islander/Samoa AC Asian/Chinese AX Asian/Other HX Hispanic/Other PACX Pac Islander/Other AI Asian/Indian C Caucasian/Non-Hispanic NA Native American UNK Unknown AJ Asian/Japanese FI Filipino OTH Other Non-White XD Declined to State M.I. AK Asian/Korean H Hispanic P Pacific Islander 8 Gender Male Female 9 E-Mail Address 10 Type of Applicant 11 Major/Academic Program CODE Check if you are: If undecided, temporarily choose GENMJ.AS.1 (SJCC ONLY). Student Applicant (SAP) See CODE SHEET - Application CANNOT be processed without an academic program. Employee Applicant (EMA) 12 Admit Status (Fill in the one which best applies to you) N I am attending college for the first time after high school. TR I am attending this college for the first time but have attended or am now attending another college. RS I am returning to this college after an absence of one or more terms. HS I plan to enroll in college while still in high school. (Form R-40 required) JS I plan to enroll in college while still in K-8. (Form R-42 required) 13 Student’s Educational Goal (Choose One) A Earn an Associate Degree and transfer I Maintain certificate or license (e.g. Nursing, Cosmetology) B Transfer to a four-year college without an Associate Degree J Educational development (intellectual, cultural) C Earn an Associate Degree without transferring K Improve basic skills in English, Reading and Math D Earn a Vocational Degree without transferring L Complete credits for high school diploma or GED E Earn a Vocational Certificate without transferring M Undecided on goal F Discover/formulate career interests/plans/goals X Unreported/Uncollected goal (Office use only) G Prepare for a new career (acquire job skills) H Advance in current job/career (update job skills) 14 Do you qualify for Veteran’s Benefits? (Choose one) 15 Language most frequently Spoken/Written: (Choose one - optional) yes no If yes: Self As a Dependent English Spanish Tagalog Vietnamese Chinese Other specify 16 Fill in the categories that are of interest to you: 1 Financial Aid Assistance 6 Basic Skills Assistance 11 Latino Student Special Programs 2 Child Care Services 7 Tutoring Assistance 12 African-American Special Programs 3 Disabled Student Services 8 English as a Second Language (ESL) 13 Intercollegiate Athletic Programs 4 Transfer Center Services 9 Extended Opportunity Program & Services (EOP&S) 14 Asian-Pacific Special Programs 5 Job/Career Assistance 10 Student Government & Activities 15 Accelerated Transfer Programs 16 Sport Specify 17 Institutional History (HS) High School Last Attended City State HIGH SCHOOL CODE From to (see CODE table) years years 18 Institutional History (Coll) College Last Attended City State COLLEGE CODE From to (see CODE table) years years 19 Graduation type: (Check the type that best describes your highest educational background) 0 Not a graduate of, and no 2 Currently enrolled in 4 Passed GED/ 6 Foreign secondary school diploma longer enrolled in high school adult high school certificate of equivalency /Certificate of Graduation 1 Special admit student 3 Received a 5 Received Certificate of 7 Received Associate’s Degree currently enrolled in K-12th grades high school diploma Cal. H.S. Proficiency 8 Received Bachelor’s Degree or higher 20 Residency Information State laws regulate student fees on the basis of California residence. OFFICE USE ONLY This statement is a certification necessary to administer the laws. Residence Code A Have you lived in California since birth? Residence Date Yes, skip to question C. No, list where you lived previously and the beginning and ending dates of your residence in that state or country. From To State/Country year year No, but I am eligible for AB-540 status. B If you answered NO to question A, and you want to be considered a California resident for enrollment purposes, answer the residency questions in both sections below. What state do you consider as your permanent home? If California, when did your present stay begin (Month/Day/Year)? Are you an active member of the US military or a dependent? yes no Are you a dependent of a parent who is a California resident? yes no Have you, or if you are under 19 years of age, have your parents, any time during the past two years: Registered to vote in a state other than California? yes no Petitioned for divorce in another state? yes no Been declared a non-resident of California for state income tax purposes? yes no Attended an out-of-state institution as a resident of that other state? yes no If you are unmarried and under 19 years of age, have you lived with one or both parents for the past two years at a California address? yes no If YES, give the address C Citizenship Select ONE. US Citizen Temporary Resident / Amnesty Student Visa (F-1 or M-1) Other Status Permanent Immigrant Refugee / Asylum AB-540 Eligible (see Schedule for details) A# (optional) Applied/Issue Date SIGNATURE REQUIRED Read the following CAREFULLY before signing I declare under penalty of perjury that the statements and information submitted in this Admissions Application are true and correct. I understand that all materials submitted by me for purposes of admission are true and correct. Falsification, withholding pertinent data or failure to report changes in residency or education status may result in District action. I understand that all materials submitted by me for purposes of admission become the property of the San Jose/Evergreen Community College District. In registering for future terms, I agree to provide true and correct information about any changes in my educational status. SIGNATURE OF STUDENT DATE OFFICE USE ONLY Information entered by Date Residency Status 1 FC 2 INST 3 OST 4 OSTE Special Admit: R-40 on file R-42 on file Student Type 1 CSEA 2 EMPL 3 IHSC 4 INT 5 OHSC 6 OHSH 7 REG Colleague ID# (No SS#, Add ID# to DADD) Application Status Incomplete Accepted Remarks NAE SHAP FINF PERC SPRO ASPR DADD PPIN SREP STRK STAL SAN JOSE CITY COLLEGE ASSOCIATE OF ARTS and TRANSFER DEGREES PROGRAM CODES 1ADS.AA.1 Alcohol and Drug Studies 1GENMJ.AA.14 General Major: Philosophy Concentration 1AJ.AA.2 Administration of Justice 1GENMJ.AA.15 General Major: Photography Concentration 1ART.AA.1 Art 1GENMJ.AA.16 General Major: Psychology Concentration 1BUS.AA.1 Business 1GENMJ.AA.17 General Major: Science: Life Concentration 1CHEM.AA.1 Chemistry 1GENMJ.AA.19 General Major: Social Science Concentration 1COMSC.AA.1 Computer Science 1GENMJ.AA.34 General Major: English/Humanities Concentration 1CNSTR.AA.1 Construction Technology 1GENMJ.AA.35 General Major: Foreign Language Concentration *1CSU.AA.3 California State University Studies 1GENMJ.AA.36 General Major: Physical Science 1GENMJ.AA.5 General Major: Dance/Drama/Speech Concentration 1LABOR.AA.1 Labor Studies 1GENMJ.AA.7 General Major: Ethnic Studies Concentration 1LIBST.AA.2 Liberal Studies 1GENMJ.AA.11 General Major: Mathematics Concentration **1UC.AA.2 University of California Studies 1GENMJ.AA.12 General Major: Music Concentration * Use this code for a transfer track to all CSU Programs of Study. See a counselor for specific direction and ask about our Accelerated Transfer Program. * 1CSU.AA.3 California State University Studies ** Use this code for a transfer track to all UC Programs of Study. See a counselor for specific direction and ask about our Accelerated Transfer Program. ** 1UC.AA.2 University of California Studies SAN JOSE CITY COLLEGE ASSOCIATE OF SCIENCE DEGREES AND CERTIFICATES PROGRAM CODES 1ACCTG.AS.2 Accounting 1ACCTG.C2.2 Accounting 1ADS.AS.1 Alcohol & Drug Studies 1ADS.C1.1 Alcohol & Drug Studies 1ADS.C2.1 Alcohol & Drug Studies 1AIR.AS.1 Air Condition & Refrigeration 1CMOS.C2.2 Mask Design Technician 1AIR.C2.2 Air Condition & Refrigeration 1CNSTR.AS.2 Construction Technology 1AIR.C3.2 Air Condition & Refrigeration 1CNSTR.C1.1 Construction Technology: Management 1AJ.AS.2 Administration of Justice 1CNSTR.C1.2 Construction Technology: Residential Maintenance 1AMT.AS.2 Advanced Manufacturing Technology 1CNSTR.C3.1 Construction Technology 1AMT.C3.2 Advanced Manufacturing Technology Technician 1COS.AS.1 Cosmetology 1APPR.APPR Apprenticeship Program 1COS.C1.1 Cosmetology: Esthetician 1ART.AS.1 Art 1COS.C3.1 Cosmetology 1BUS.C1.2 Business: Electronic Commerce 1CT.C2.2 Computer Technology 1BUS.C2.5 Business: Electronic Commerce 1DENT.AS.1 Dental Assisting 1BUS.C3.6 Business: Electronic Commerce 1DENT.C3.1 Dental Assisting 1BUS.AS.2 Business: Electronic Commerce 1ECE.AS.1 Early Childhood Education 1BUS.C1.3 Business: Entrepreneurship 1ECE.C1.1 Early Childhood Education 1BUS.C2.6 Business: Entrepreneurship 1ECE.C2.1 Early Childhood Education 1BUS.C3.7 Business: