Salem Community College

" Providing optional demographic information is for statistical purposes only and will not affect your admission to SCC. Ethnicity Do you consider yourself to be Hispanic/Latino? n American Indian or Alaskan Native n Asian Gender n Male n Female Term for which you desire admission Do you plan to enroll: n Part-time (11 or fewer credits per semester) n Fall 20 __________ n Spring 20 __________ n Summer 20 __________ n Full-time (12 or more credits per semester) The SCC Educational Opportunity Fund (EOF) Program provides comprehensive supportive services and financial assistance to eligible students. n Yes, I am interested in receiving more information. Do you have a documented learning disability? n Yes n No To receive accommodation, you must provide documentation to Student Affairs. Are you a veteran? n Yes n No Are you interested in playing a sport? If so, please check. n Co-ed Golf n Men's Baseball n Men's Basketball n Men's Soccer n Women's Basketball n Women's Soccer Do you plan to transfer to a four-year college with which SCC has a dual-admission or articulation agreement? If YES, please select one: n Chestnut Hill College n Excelsior College n Kaplan University n Savannah College of Art and Design n Strayer University n Thomas Edison State College Previous Education Did or will you graduate from high school? n Yes n No If NO, did you earn a GED? n Yes (month/year) ______________ n No List last high school attended Name of High School List all colleges attended Name of College City/State City/State Dates Attended Month/Year Graduated GPA Dates Attended Degree Month/Year Transfer Graduated Credit n Wesley College n Wilmington University n Women's Softball n Yes n No In addition, select one or more of the following racial categories to describe yourself: n Black or African American n Native Hawaiian or Pacific Islander n White n Prefer not to report n Other Students are required to take the College placement test or provide proof of college readiness after admission but prior to registering for classes. Please submit an official, high school/GED/college transcript to Enrollment and Transition Services. Certification: I certify that these answers are true, correct and complete to the best of my knowledge. I also understand that my application is not considered complete and accepted until all necessary documentation is provided to Enrollment and Transition Services. I understand that submission of this application does not guarantee acceptance into Nuclear Energy Technology, Nursing, Practical Nursing or Scientific Glass Technology, which have selective admission requirements. I understand that if I am a new student, enrolled full-time (12 or more credits) and born after 1957, I must submit proof of immunization for measles, mumps and rubella and hepatitis B in accordance with New Jersey law (NJAC 9:2-14). Further, I agree to abide by the rules and regulations of Salem Community College as outlined in the Student Handbook. I consent that photographs and video of me taken on campus or during SCC-sponsored activities become the property of Salem Community College, and permit the College to use those images for promotional use. In addition, all media representing SCC created for class projects and/or extracurricular activities also become the property of the College. I certify that I am registered with Selective Service if I am a male age 18 to 25. Parent or legal guardian signature is required if the applicant is under age 18. By signing this application, the parent or guardian agrees that the applicant will adhere to all rules and regulations as outlined in the Student Handbook. Signature _____________________________________________________________ Date __________________________________________ 3/12

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