APPLICATION FOR ADMISSION
($15 Application Fee Required)
-- * Items are required --
Online Admissions Application Deadline Dates:
Winter 2010 (Jan. 6-Mar. 18) – applications due Dec. 18th
Winter 2010 B-Term (Feb. 10-Mar. 18) – applications due Jan. 20th
Spring 2010 (Mar. 29-Jun. 9) – applications due March 8th
Spring 2010 B-Term (May 4-Jun. 9) – applications due Apr. 13th

* First Name:

Middle Name/Initial:

* Last Name:

Social Security Number:

* Email Address:

* Address:

* City:

* State:
AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

* Zip Code:

* Primary Phone:

Secondary Phone (cell/business):

County:

* First Name:

* Last Name:

* Address:

* City:

* State:
AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

* Zip Code:

* Primary Phone:

Secondary Phone (cell/business):

Date of Birth:

Sex:
- Male Female

Race:
- American Indian Asian/Pacific Islander Black/African American Hispanic White, Non-Hispanic Other

Citizenship Status:

Are you a US Citizen?
Yes   No

Alien, Non-Resident?
Yes   No

Alien, Resident?
Yes   No

Are you a Georgia Resident?
Yes   No

Are you a Veteran?
Yes   No

Did you graduate from high school?

Yes
No

Year Graduated:
Year Widthdrew:

Have you received your GED?

Yes
No

Year Received:

Highest Grade Completed:
- 12 11 10 9 8 7 6 5 4 3 2 1 0

College Years Completed:
- 4 3 2 1 0

Degree:

Have you taken any of the following tests?
SAT    CPE    ASSET    ACT    COMPASS

Do you wish to enroll in a high school program?
Tech Prep    Accel    Dual Enrollment    Joint Enrollment

High School (#1)

Name:

Address:

City/State/Zip:

Attended From (date):

To (date):

Courses taken:

Diploma/Degree:

High School (#2)

Name:

Address:

City/State/Zip:

Attended From (date):

To (date):

Courses taken:

Diploma/Degree:

Technical Colleges or Schools (#1)

Name:

Address:

City/State/Zip:

Attended From (date):

To (date):

Courses taken:

Diploma/Degree:

Technical Colleges or Schools (#2)

Name:

Address:

City/State/Zip:

Attended From (date):

To (date):

Courses taken:

Diploma/Degree:

College/University (#1)

Name:

Address:

City/State/Zip:

Attended From (date):

To (date):

Courses taken:

Diploma/Degree:

College/University (#2)

Name:

Address:

City/State/Zip:

Attended From (date):

To (date):

Courses taken:

Diploma/Degree:

Other (#1)

Name:

Address:

City/State/Zip:

Attended From (date):

To (date):

Courses taken:

Diploma/Degree:

Other (#2)

Name:

Address:

City/State/Zip:

Attended From (date):

To (date):

Courses taken:

Diploma/Degree:

Quarter you wish to enter:
- Winter Spring Summer Fall

Year:

Classes you plan to attend:
- Day - Part Time Day - Full Time Evening - Part Time Evening - Full Time

Do you plan to pursue:
- Associate Diploma Certificate

Student Type:
- Undeclared Transient Apprenticeship Beginning Post Secondary Option Joint Enrollment Returning Transfer Tech Prep Audit Senior Citizen

Program of Study:
Choice 1:
Choice 2: