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OFFICE USE ONLY NAME San Jose/Evergreen District APPLICATION FOR ADMISSION Colleague ID # LAST Term & College for which you are applying: FALL SPRING SUMMER 20 Date Check ONE college only 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 /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 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 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 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: Entrepreneurship 1ELECT.AS.3 Electronics Technology 1BUS.AS.3 Business: Entrepreneurship 1ELECT.C1.4 Electronics: Computer Repair 1BUS.C1.4 Business: Management 1ELECT.C1.5 Electronics Assembler 1BUS.C2.7 Business: Management 1ELECT.C1.6 Biomedical Electronics Technology 1BUS.C3.8 Business: Management 1ELECT.C2.2 Electronics Technician 1BUS.AS.4 Business: Management 1ELECT.C3.2 Electronics: Microwave Technician 1BUS.C1.5 Business: Marketing 1ELECT.C3.3 Electronics Technology Technical Associate 1BUS.C2.8 Business: Marketing 1GENMJ.AS.1 General Major: Art Concentration 1BUS.C3.9 Business: Marketing 1GENMJ.AS.2 General Major: Business Concentration 1BUS.AS.5 Business: Marketing 1GENMJ.AS.3 General Major: Child/Family Studies Concentration 1CA.AS.3 Computer Applications 1GENMJ.AS.4 General Major: Dance/Drama/Speech Concentration 1CA.C1.3 Computer Applications 1GENMJ.AS.6 General Major: Ethnic Studies Concentration 1CA.C2.3 Computer Applications 1GENMJ.AS.10 General Major: Mathematics Concentration 1CA.C3.3 Computer Applications 1GENMJ.AS.11 General Major: Music Concentration 1CIS.C2.15 CIS: Microsoft Networks-MCSE-2003 1GENMJ.AS.12 General Major: Philosophy Concentration 1CIS.C2.16 CIS: Microsoft Networks-MCSA-2003 1GENMJ.AS.13 General Major: Photography Concentration 1CIS.AS.3 CIS: Network Administration 1GENMJ.AS.14 General Major: Science: Life Concentration 1CIS.C1.2 CIS: Network Administration - Novel 1GENMJ.AS.19 General Major: English/Humanities 1CIS.C1.3 CIS: Network Admin - NT Network 1GENMJ.AS.20 General Major: Foreign Language 1CIS.C1.8 CIS: Web Application Solutions 1GENMJ.AS.21 General Major: Physical Science 1CIS.AS.16 CIS: Web Site Application Solutions 1HSCI.C1.3 Clinical Technician 1CIS.C3.9 CIS: Web Site Application Solutions 1HSCI.C1.4 Polysomnographic Technology I 1CIS.AS.15 CIS: Web Site Administration 1LABOR.AS.1 Labor Studies 1CIS.C1.7 CIS: Web Site Administration 1LABOR.C1.1 Labor Studies 1CIS.C2.1 CIS: Web Site Administration 1LABOR.C2.1 Labor Studies 1CIS.C2.4 CIS: Web Site Administration 1LASER.AS.2 Laser Technology 1CIS.C3.8 CIS: Web Site Administration 1LASER.C3.2 Laser Technology 1CIS.C2.3 CIS: Network Administration 1MACH.AS.2 Machine Technology 1CIS.C3.3 CIS: Network Administration 1MACH.C1.1 Machine Technology: CNC Operator 1CIS.C1.11 CIS: JAVA Enterprise 1MACH.C1.2 Machine Technology: Entry Level Machinist 1CIS.C2.11 CIS- JAVA Enterprise: J2EE Business Component Developer 1MACH.C3.1 Machine Technology 1CIS.C2.12 CIS- JAVA Enterprise: SOA for Managers and Business Analysis 1MMDA.AS.1 Multimedia/Digital Arts: Digital Arts 1CIS.C2.13 CIS- JAVA Enterprise: J2EE Web Component Developer 1MMDA.AS.2 Multimedia/Digital Arts: Web Design 1CIS.C2.14 CIS: MS.NET Application Development 1MMDA.C1.1 Multimedia/Digital Arts: Digital Arts 1CIS.C2.17 CIS: CISCO Networks-Wireless LANs 1MMDA.C1.2 Multimedia/Digital Arts: Web Design 1CIS.C2.18 CIS: CISCO Networks-Security 1MMDA.C2.1 Multimedia/Digital Arts: Digital Arts 1CIS.C2.19 CIS: Network Security 1MMDA.C2.2 Multimedia/Digital Arts: Web Design 1CIS.C2.20 CIS: UNIX Networks 1MMDA.C3.1 Multimedia/Digital Arts: Digital Arts 1CIS.AS.2 CIS: Computer Programming 1MMDA.C3.2 Multimedia/Digital Arts: Web Design 1CIS.AS.14 CIS: Computer Programming 1REST.AS.2 Real Estate 1CIS.C1.5 CIS: Computer Programming 1REST.C1.3 Real Estate Appraiser 1CIS.C2.2 CIS: Computer Programming 1REST.C1.4 Real Estate Sales 1CIS.C3.7 CIS: Computer Programming 1REST.C2.2 Real Estate Broker CODE TABLES High School Codes College Codes 053075 Abraham Lincoln High School California Community Colleges California State Colleges and Universities 053077 053078 Archbishop Mitty High School 445076 156250 Bakersfield 053080 Bellarmine High School 415062 Canada College 489150 California Maritime Academy 053081 Blackford High School 015235 196140 California Poly, Pomona 053082 385092 City College of 406145 Cal Poly, San Luis Obispo 050718 015257 College of the Alameda 046242 Chico 053083 415151 196135 Dominguez Hills 053169 Evergreen Valley High School 345124 106260 Fresno 053086 Foothill High School 405650 306106 Fullerton 051040 435184 016178 Hayward 053088 075268 126450 Humboldt 052347 Henry 435679 Evergreen Valley College 196131 Long Beach 053462 Homestead High School 435227 196133 Los Angeles 053087 Independence High School 105240 276001 Monterey Bay 053090 High School 435263 196770 Northridge 053092 195257 Glendale College 346760 Sacramento 053091 Leland High School 275129 366184 San Bernardino 002298 Live Oak High School 015450 376720 San Diego 051510 Los Altos High School 015001 386796 San Francisco 053463 Los Gatos High School 245475 436727 San Jose 053463 015570 376820 San Marcos 051978 435861 Mission College 496710 Sonoma 051960 Menlo High School 505500 506730 Stanislaus 050170 Menlo-Atherton High School 275270 Monterey Peninsula College 053094 Mount Pleasant High School 015610 052075 Mountain View High School 435680 San Jose City College University of California 053095 Notre Dame High School 415711 053099 Oak Grove High School 015236 Vista College 017846 Berkeley 053107 Overfelt High School 435860 577750 Davis 052350 003814 Out of California College 307781 Irvine 051976 Piedmont Hills High School 003815 Out of Country College 197887 Los Angeles 053096 Pioneer High School 337797 Riverside 053097 377837 San Diego 053344 Prospect High School 001831 San Francisco 051955 Sacred Heart Preparatory 427677 Santa Barbara 053343 Saratoga High School 447765 Santa Cruz 053098 San Jose High Academy 053280 Santa Clara High School California Independent Colleges and Universities (Local) 053106 053100 Silver Creek High School 418125 College of Notre Dame 053103 Westmont High School 018518 Mills College 053105 018624 St. Mary’s College 053113 438792 003812 Out of California High School 438830 003813 Out of Country High School

EVERGREEN VALLEY COLLEGE ASSOCIATE OF SCIENCE DEGREES AND CERTIFICATES PROGRAM CODES 2ACCTG.AS.1 Accounting 2BIS.C1.22 BIS (Information Processing Specialist) 2ACCTG.C2.1 Accounting 2BIS.C1.17 BIS (Legal Office Assistant) 2AJ.AA.1 Administration of Justice 2BIS.C1.25 BIS (Medical Office Assistant) 2AJ.AS.1 Administration of Justice 2CADD.AS.1 Computer Aided Design & Drafting 2ART.AS.1 Art & Design (Design Emphasis) 2CADD.C1.3 AutoCAD 2ART.AS.2 Art & Design (Studio 2D) 2CADD.C1.1 Mechanical CADD 2ART.AS.3 Art & Design (Studio 3D) 2CADD.C1.2 Mechanical Drafting and Design 2AUTO.AS1 Automotive Technology (Drivetrain & Chassis) 2CHEM.AA.1 Chemistry 2AUTO.AS.3 Automotive Technology (Fuel & Electrical) 2COMS.C1.1 Communication Studies 2AUTO.C3.2 Automotive Technology (Advanced Automotive Training) 2CIT.AS.1 CIT 2AUTO.C3.1 Automotive Technology (Fuel & Electrical) 2CIT.C1.4 CIT (Unix System Administration) 2AUTO.C3.1 Automotive Technology (American Honda) 2CIT.C1.5 CIT (Oracle Database Administration) 2AUTO.C2.1 Automotive Technology (Drivetrain & Chassis) 2CIT.C1.8 CIT (Oracle Applications Developer) 2AUTO.C1.1 Automotive Technology (Basic Skills Entry-Level) 2CIT.C1.9 CIT (Web Programming) 2AUTO.C1.2 Automotive Technology (Engine Service) 2ENGR.AS.1 Engineering 2BUS.AA.1 Business Administration 2ENGR.AA.1 Engineering 2BIS.AS.3 BIS (Information Processing Specialist) 2ENGL.AA.1 English 2BIS.AS.4 BIS (Digital Media Design Specialist) 2GEN.AA.1 General Studies 2BIS.AS.1 BIS (General Business) 2ART.C1.1 Jewelry 2BIS.C3.3 BIS (Information Processing Specialist) 2LA.AA.1 Legal Assistant/Paralegal 2BIS.C3.4 BIS (Digital Media Design Specialist) 2LA.AS.1 Legal Assistant/Paralegal 2BIS.C3.1 BIS (General Business) 2LA.C2.1 Legal Assistant/Paralegal 2BIS.C1.20 BIS (Accounting Specialist) 2LE.C2.1 Law Enforcement/Police Academy 2BIS.C1.16 BIS (Administrative Assistant) 2MUS.C1.1 Music 2BIS.C1.14 BIS (Bookkeeping Assistant) 2NURS.AS.1 Nursing 2BIS.C1.19 BIS (Business Systems Assistant) 2PERF.C1.1 Performing Arts 2BIS.C1.15 BIS (Computer Application Specialist) 2PSYCH.AA.1 Psychology 2BIS.C1.26 BIS (Computer Systems Assistant) 2IGETC.AA.1 University of California (IGETC) Studies 2BIS.C1.21 BIS (Digital Media Design Specialist) 2CSU.AA.1 California State University Studies 2BIS.C1.27 BIS (General Business Assistant) 2HIST.C1.1 Women's Studies 2UND Undecided

AA Associate in Arts Degree LEGEND AS Associate in Science Degree C3 Certificate of Achievement (30 + units) C2 Certificate of Specialization Level II (18-29.5 units) C1 Certificate of Specialization Level I (6-17.5 units)