Salem Community College Catalog for 2011-2012
Issue link: https://www.e-digitaleditions.com/i/42424
" APPLICATION FOR ADMISSION Please mail completed application, with $27 application fee, to: Salem Community College Enrollment and Transition Services 460 Hollywood Avenue Carneys Point, NJ 08069 856.351.2703 www.salemcc.edu info@salemcc.edu Information in shaded boxes MUST be completed for application to be processed. Please print clearly. n First-time application n Readmit (for SCC graduates or students who have not attended in three or more years) Is your admissions application fee being waived? n Yes n No If YES, provide documentation Legal Name _______________________________________________________________________________________________________________ Last First Full Middle Mailing Name (Name by which you want to be referred in correspondence, if different than legal name) _________________________________________________________________________________________________________________________ Last First Primary Address (Place where you will live and receive mail while attending SCC) Street Apt.# City State Zip Code County of Legal Residence __________________________________ Full Middle Suffix (e.g. Jr., III) Former Name Permanent Address (Only if different from primary address) Street Apt.# City State Zip Code State of Legal Residence ______________________________________ Phone: Home (______)_______________________ Cell (______)_______________________ Work (______)_________________________ Date of Birth _________________________________________ E-mail Address _____________________________________________________ Emergency Contact Name ___________________________________________________________________________________________________ Phone ___________________________________________________ Relationship to Student ________________________________________ Suffix (e.g. Jr., III) Former Name Are you a U.S. citizen? n Yes n No Social Security Number____________________________ (optional) Government ID Number________ If NO, what is your country of citizenship? _____________________________ Country of Birth? ______________________________________ If NO, do you require a I-20 for student visa? n Yes n No SEVIS ID Number__________________________________________________ If NO, what type of visa do you presently hold?_________________________________________________________________________________ VISA Number ________________________ Issuing Country _______________________ Date Issued_________________ Expiration Date ____________ If NO, please provide a photocopy of your permanent alien resident card (including photo and ID number) Is English your native language? n Yes n No If NO, what is the language spoken at home?________________________________ International students: Please contact Enrollment and Transition Services for admission information.