Admissions Application Your Responses to Questions with an Asterisk (*) Are Voluntary
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Brookhaven Campus Cedar Valley Campus 3939 Valley View Lane 3030 N. Dallas Ave. Farmer Branch, TX 75244 Lancaster, TX 75134 972-860-4883 972-860-8201 dcccd.edu/brookhaven dcccd.edu/cedarvalley Eastfield Campus El Centro Campus 3737 Motley Drive 801 Main St. Mesquite, TX 75150 Dallas, TX 75202 972-860-7167 214-860-2000 dcccd.edu/eastfield dcccd.edu/elcentro Mountain View Campus North Lake Campus 4849 W. Illinois Ave. 5001 N. MacArthur Blvd. Dallas, TX 75211 Irving, TX 75038 214-860-8600 972-273-3183 dcccd.edu/mountainview dcccd.edu/northlake Richland Campus 12800 Abrams Road Dallas, TX 75243 972-238-6100 dcccd.edu/richland Admissions Application for Dallas College Educational opportunities are offered by Dallas College without regard to race, color, religion, gender, national origin, disability, sexual orientation, gender identity, gender expression or any other basis prohibited by law. Form No. 0664-07/20 Dallas College Home Page URL: dcccd.edu INSTRUCTIONS 1. All applicants must complete Part A and Part I. 2. Applicants wishing to claim Texas residence for tuition purposes must complete the following: • Students of a Texas public college or university during the past 12 months, who paid resident (in-state) tuition, without a tuition waiver, must complete Parts A, B and I. • Recent high school graduates must complete Parts A, B, C, D and I. • Dependents of Texas residents must complete Parts A, B, C, D, E, G and I. • Applicants who did not attend a Texas public college or university during the past 12 months must complete Parts A, B, C, D, E, F and I. • Part H is for any additional information an applicant believes the college should know in evaluating Texas residence. 3. Applicants who are not claiming Texas residence for tuition purposes must complete Parts A, B, C and I only. BIOGRAPHICAL INFORMATION Questions with an asterisk (*) are voluntary, and the information provided will remain confidential. In addition, supplying your Social Security number, gender, and ethnicity enables a more expedient match of test scores, transcripts, financial aid benefits, and tuition refunds. APPLICATION METHODS Applicants may apply one of three ways: 1. An online application process is available for credit students. 2. Apply Texas Online Application. 3. An Adobe PDF version of the application is available to download and complete. Needs to be submitted to the campus Admissions Office. Please print in blue or black ink and complete all appropriate parts. The Family Educational Rights and Privacy Act (FERPA) affords students certain rights with respect to their education records. If you wish to protect your directory information from disclosure, proceed to the following website or contact the Admissions/Registrar’s Office. Form No. 0664-07/20 Dallas College Home Page URL: dcccd.edu STUDENT NAME: Student ID Number: CAMPUS YOU PLAN TO ATTEND Brookhaven Cedar Valley Eastfield El Centro Mountain View North Lake Richland SEMESTER YOU PLAN TO ATTEND Fall (August-December) Winter Term (December-January) Spring (January-May) May Term (May) Summer (June-August) Campuses of Dallas College Students who apply to one of the campuses listed above are eligible to FOR OFFICE USE attend any of the campuses that are listed. Date Received: Admissions Application Your responses to questions with an asterisk (*) are voluntary. Residency Code: Part A: Biographical Information Your Social Security number or tax identification number is required. Your number will remain confidential. Supply your Social Security number enables a more expedient match of your test scores, transcripts & financial aid benefits. Choose One The following is my Social Security number or tax identification number: County Code: I do not have a Social Security number or tax identification number. Email Address: (This is our primary means of communication) How Admitted: * Gender M F NAME Give full legal name. Do not use initials unless initials are your legal name. Last First Middle Give names, if different from above, that are on transcripts from other institutions. Date of Birth (MM/DD/YY) Term: Current Street Address (must be a physical address) Apartment # Citizen: City State Zip Do you live in Dallas County? YES NO TSI Status: Permanent Mailing Address (can be a P.O. box number) Cond. Agreement: Home Number (Include Area Code) Work Number (Include Area Code) Cell Number (Include Area Code) Person to Identify in the event of an emergency Rising Star: Name Phone Number ( ) * Ethnicity and Racial Background: (How do you identify yourself?) This information will be used for federal Tech Prep: and/or state law reporting purposes only. Are you Hispanic or Latino? Yes No unknown or I choose not to respond. Dual Credit: Please select the racial category or categories with which you most closely identify. Check as many as apply. White American Indian or Alaskan Native Black/African American Unknown Asian/Pacific Islander Native Hawaiian or another Pacific Islander International/Non-Immigrant Staff: My Primary Language is: Place of Birth: State: Country: REASON FOR ATTENDING I will take courses: To Earn a One-Year Certificate (APPN.CERT) To Earn a Two-Year Degree (APPN.ASSOCIATE) To Improve Job Skills (APPN. J/R) To Transfer to a University (APPN.U/T) For Personal Interest (APPN.N/D) Uncertain (APPN.UNCERTAIN) Military-Veteran Status If you have any military affiliations, please indicate by selecting all that apply: Current/Former member of the U.S. armed forces Dependent of a veteran Current/Former member of the National Guard Dependent of a deceased veteran Current/Former member of the Reserves Dependent of a veteran with a combat-related injury None of the above FORM NO: 0664-07/20 ~ 1 ~ Admissions Application 1. Are you a U.S. citizen? YES NO If “no,” of what country are you a citizen? 2. If you are not a citizen, do you hold Permanent Resident status (valid I-551) for the U.S.? YES NO (If “Yes,” date permanent resident card issued : / / .) (Month) (Day) (Year) Enclose a copy of both sides of the card. 3. If you are not a U.S. citizen or permanent resident, do you have an Application to Register Permanent Residence (form I-485) pending with the U.S. Citizenship and Immigration Services (USCIS)? YES NO (If “Yes,” enclose a copy of your Notice of Action from the USCIS, form I-797C.) 4. If you are not a citizen or permanent resident and have no application pending with the USCIS, did you live or will you have lived in Texas for at least 36 consecutive months immediately before graduating from high school or receiving a GED in Texas? YES NO (If “Yes,” please submit a completed “Affidavit of Intent to Become a Permanent Resident”) Educational Data Name of High School Attended: City: State: Which best describes your high school or international equivalent: Texas High School Out-of-Texas High School Out-of-Texas Private School Home School Non-U.S. High School None of the Above Graduated/Expected Graduation Date (Month) (Year) Did not graduate from high school Please answer each question: Did you take a Career Pathway course or courses for college credit? Yes No Did or will you graduate with an IB diploma? Yes No If you did not graduate from high school, do you have a GED? Yes No If yes, completion date (Month) (Year) which version: English Spanish In what state did you receive your GED? Official transcripts for ALL previous college work MUST be submitted. Failure to list all institutions will be considered an intentional omission and may result in the denial of future enrollment. List ALL Colleges attended. Attach separate sheet, if necessary. Date attended Date attended Hours Degree/Cert. Currently on Name and Location (City and State) FROM TO Credits Received Suspension (most recent first) Month/Year Month/Year (if any) Yes / No 1. 2. 3. 4. 5. I have no previous college experience. Texas Success Initiative (TSI) An institution of higher education shall assess the academic skills of each entering undergraduate student to determine the student’s readiness to enroll in freshman-level academic coursework. Some students may be exempt from meeting the requirement of the TSI; however, students will be required to meet college course prerequisite requirements. Please read the following and check the appropriate box that applies to you: I have taken: STAAR SAT ACT I have taken: TSIA or formerly approved TSI assessment (Accuplacer/Asset/Compass/THEA/TAKS). I have not taken one of the tests listed above. I understand that I may have to take a test prior to registration. Exemptions: 1. I am eligible for exemption from additional TSI assessment. 2. I claim an exemption because I am serving on active duty as a member of the U.S. armed forces, the Texas National Guard, or as a member of a reserve component of the U.S. armed forces and have been serving for at least 3 years preceding enrollment. Official documentation must be provided to prove exemptions. 3. I claim an exemption because I was honorably discharged, retired, or released from active duty as a member of the U.S. armed forces, the Texas National Guard or service as a member of a reserve component of the U.S. armed forces on or after Aug. 1, 1990. Official documentation must be provided to prove exemptions. FORM NO: 0664-07/20 ~ 2 ~ Admissions Application Texas Higher Education Coordinating Board rule 21.731 requires each student applying to enroll at an institution to respond to a set of core residency questions for the purpose of determining the student’s eligibility for classification as a resident. Part B: Previous Enrollment 1. During the 12 months prior to the term for which you are applying, did you attend a public college or university in Texas in a fall or spring term? YES NO If you answered “no,” continue on to Part C – Residency Claim.