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APPLICATION FOR ADMISSION APPLICA Please read the instructions on the…
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Created: Thu Oct 3 11:22:13 2002
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APPLICATION FOR ADMISSION
APPLICA
Please read the instructions on the front of this booklet before completing this form. A $35.00 non-refundable
application fee must accompany this form. It is not necessary to re-apply if you have attended SLCC within the
last two years, or have applied for admission during the past year. Use only black or blue ink to complete this form.
ENROLLMENT SERVICES
When do you plan to plan to attend SLCC? ! Fall ! Summer ! Spring of 200____ P.O. Box 30808, 4600 S. Redwood Road
.O. Bo Redwood
edwoo
Lake
Salt Lake City, UT 84130-0808
PERSONAL DATA
PERSONAL DA
SLCC ID#____________________________ Social Security Number ____________________________ Date of Birth ____________________________
Name _______________________________________________________________________________________________________________________
(Last) (First) (Middle)
Former Name(s) ____________________________________________________________________________________________________________
Address Information
Mailing (MA) ___________________________________________________________________________________________________________
(Street) (City) (State) (ZIP Code) (Phone)
Permanent (PR) _________________________________________________________________________________________________________
(Street) (City) (State) (ZIP Code) (Phone)
Additional Phone Information (SPATELE) Contact in case of emergency:
Work (BU) __________________________ Cell (Cell) __________________________ Name _______________________________________
Relationship __________________________________
E-mail Address (GOAEMAL) ______________________________________________
Phone _______________________________________
BELOW BY SLC REPORTING ONLY
THE ITEMS BELOW ARE OPTIONAL AND ARE USED BY SLCC FOR REPORTING PURPOSES ONLY.
INFORMATION YOU PROVIDE IS COMPLETELY CONFIDENTIAL AND WILL NOT AFFECT YOUR ADMISSION TO THE COLLEGE. (SPAPERS)
INFORMA COMPLETELY CONFIDENTIAL
OMPLETEL NOT AFFECT COLLEGE
OLLEGE.
Your ethnic background:
backgr that apply
ply:
Check all that apply:
! American Indian/Native American ! African-American/Black ! Asian ! Male ! Married ! Single ! Veteran
! Hispanic/Latino/a/Chicano/a ! White/Anglo/Caucasian ! Pacific Islander ! Female ! Widow/er ! Reserves/Nat'l Guard
EDUCATIONAL BACKGROUND
EDUCATIONAL BACK
CKGROUND
! High School Graduate Month __________ Day __________ Year __________ ! Not a High School graduate (check one box below)
! Will graduate High School before enrolling at SLCC ! Have GED Month __________ Year __________
Month __________ Day __________ Year __________ ! Did not pass/have not taken GED exam
While attending high school, were you concurrently enrolled for any classes at SLCC? ! Yes ! No
Name City, State, Country Dates (mo/day/yr) of
High schools
attended Attendance _____________________________________
(SOAHSCH) ______________________________________ ___________ to ___________
_____________________________________ ______________________________________ ___________ to ___________
_____________________________________ ______________________________________ ___________ to ___________
Colleges or ! BYU - Idaho/Ricks (BYI) ___________ to ___________ ! Southern Utah Univ (SUU) ___________ to ___________
universities ! BYU - Provo (BYU) ___________ to ___________ ! Univ of Phoenix (UOP) ___________ to ___________
attended ! Coll of Eastern Utah (CEU) ___________ to ___________ ! Univ of Utah (UOU) ___________ to ___________
(SOAPCOL)
! Dixie State College (DIX) ___________ to ___________ ! Utah State Univ (USU) ___________ to ___________
! SLCC ___________ to ___________ ! Utah Valley State U (UVS) ___________ to ___________
! Snow College (SNO) ___________ to ___________ ! Weber State Univ (WSU) ___________ to ___________
! Westminster (WMR) ___________ to ___________
Other _______________________________________________________________________ ___________ to ___________
Other _______________________________________________________________________ ___________ to ___________
If you would like to have your previous college credits or military experience evaluated for transfer to SLCC, arrange to have official transcripts from each
college mailed directly to the SLCC Enrollment Services office. In addition, phone or visit the Enrollment Services office to complete a "Request for
Evaluation of Transfer Credit" form. NOTE: Faxed transcripts are not official and will not be evaluated.
RESIDENCY
How long have you lived continuously in Utah? Years __________ Months __________
Do you have a Utah Driver's License? ! No ! Yes License Number _________________________
Help us determine your residency by listing what you have been doing and where you have been for the past three years.
From (mo/yr) To (mo/yr) City/State Primary Activity (work, schools attended, military service)
__________________ ___________________ _________________________ _____________________________________________________
__________________ ___________________ _________________________ _____________________________________________________
__________________ ___________________ _________________________ _____________________________________________________
Are you a U.S. Citizen? ! No ! Yes State or Country of birth _____________________________________________________________
If you are not a US citizen, please check the appropriate box below.
! Permanent Resident (card must be shown to Enrollment Services) "A" number ___________________
! Refugee (card or passport must be shown to Enrollment Services) "A" number ____________________
! Refugees: If you have lived in Utah less than 12 months, please indicate where you lived immediately prior to living in Utah ____________________
! International Type of Visa: ____________ Country: ____________ What school issued your I-20 ___________________________________
! Other _________________________________________________________________________________________________________________
ONLY
OFFICIAL USE ONLY ! Resident ! Non-resident ! Check Attached
Approved by Date
ACADEMIC PLANS (SAAADMS)
! Complete a Degree, Diploma, or Certificate at SLCC. ! AA ! AS ! AAS ! APE ! Diploma ! Certificate
You will be admitted as a matriculated (degree-seeking) student. Major ________________________________
Please list your intended major and the type of credential you plan to earn. See enclosed list of majors/programs
! Personal Interest
! Earn a Certificate of Completion in a Community/Continuing Ed Program.
You will be admitted as a non-degree seeking student, and Major/Program __________________________
will not be eligible for Financial Aid. See enclosed list of majors/programs
! Take classes to transfer to another college or university without completing a full program at SLCC.
You will be admitted as a non-degree seeking student, and will not be eligible for Financial Aid.
! Enroll in an Apprenticeship Program, not seeking a degree.
You will be admitted as a non-degree seeking student, and will not be eligible for Financial Aid. __________________________________
Please indicate the classes you plan to take. __________________________________
! Enroll in an Apprenticeship Program, seeking an AAS degree.
You will be admitted as a matriculated (degree-seeking) student. Major/Program __________________________
Please indicate which apprenticeship program you plan to enter. See enclosed list of majors/programs
! Enroll in a Skills Center non-credit program of study.
Please indicate your intended Skills Center program. Program _______________________________
Are you planning to transfer to another college or university after attending SLCC? ! Yes ! No ! Not sure
! BYU - Hawaii (BYH)) ! Dixie State College (DIX) ! Southern Utah Univ (SUU) ! Weber State Univ (WSU)
What schools ! BYU - Idaho/Ricks (BYI) ! Franklin University (FU) ! Univ of Phoenix (UOP) ! Westminster (WMR)
are you ! BYU - Provo (BYU) ! Idaho State (ISU) ! Univ of Utah (UOU) ! Other ______________
considering? ! Columbia College (CC) ! LDS Business College (LDS) ! Utah State Univ (USU) ! Other ______________
! Coll of Eastern Utah (CEU) ! Snow College (SNO) ! Utah Valley State U (UVS)
How did you hear about SLCC? ! advertising ! family/friend ! counselor/teacher ! agency/sponsor
Why did you select SLCC? ! course/degree offerings ! location(s) ! entrance requirement ! cost
SIGNATURE
SIGNATURE
I hereby certify that the answers I have provided on this form are true, and I understand that providing false information
on this form may result in denial of admission and/or Financial Aid. I agree to comply with all rules, regulations and
requirements of Salt Lake Community College. I authorize SLCC to release academic information to any organization
which is providing funding for my education. I understand that the application fee is non-refundable. I also understand
that all transcripts submitted to SLCC become the property of the College and will not be reproduced or returned.
Signature ______________________________________________ Date __________________________ Non-refundable Do not write in this space.
Community Writing Center
511 West 200 South, Suite 100
Salt Lake City, Utah 84101
(801) 957-4992
E- Campus
http://ecampus.slcc.edu
Granite District Technology Center
Granit Distric
anite ict Cen
ent
500 East 3300 South
Salt Lake City, Utah 84106
(801) 481-7150
International Airport Center
551 North 2200 West
Salt Lake City, Utah 84116
(801) 957-4448
Jordan Campus
3491 West Wights Fort Rd. (3400 W. 9000 S.)
West Jordan, Utah 84088-8818
(801) 957-2600
Jordan District Technical Center
Jordan Distric
ict Cen
ent
852 East 9085 South
Sandy, Utah 84094
(801) 565-7582
Meadowbrook Campus
250 West 3900 South
Salt Lake City, Utah 84107
(801) 957-4530
Metro Learning Center
115 South Main
Salt Lake City, Utah 84101 APPLICATION FOR ADMISSION
APPLICA FOR
Millcreek Center
1. Complete and sign this application for admission.
1521 East 3900 South
Salt Lake City, Utah 84124
(801) 957-3106 2. Return application with $35 non-refundable
application fee to:
Miller Campus
9750 South 300 West Enrollmen Services
ollment ervic
Enrollment Ser vices
Sandy, Utah 84070 Communit College
ommunity
Salt Lake Community College
(801) 957-5200 .O. Bo
P.O. Box 30808
City
Salt Lake City, UT 84130-0808
Redwood Campus
4600 South Redwood Road
P.O. Box 30808 3. Students planning to enroll in English or
Salt Lake City, Utah 84130-0808 mathematics classes must submit recent ACT
(801) 957-4111 scores. If you do not have recent ACT scores,
you must take the CPT test on campus for
Sandy Center placement into these classes. Information
830 East 9400 South about the CPT test is available from the SLCC
Sandy, Utah 84094 Assessment Center at (801) 957-4269.
(801) 957-3717
International Students:
South City Campus All international students on non-immigrant visas
1575 South State Street may apply to SLCC only through International
Salt Lake City, Utah 84115 Student Services (ISS). Please contact ISS at
(801) 957-3000 (801) 957-4528 or visit the ISS web site at
www.slcc.edu/iss for international application
Tooele Center
Cen
ent and other international admissions information.
1021 West Vine Street
Tooele, Utah 84074
(435) 882-5070
SLC: 957-5566
AFFIRMA AC TION/EQUAL
AFFIRMATIVE AC TION/EQUAL
OPPORTUNIT Y STATEMENT
OPPORTUNIT STA
TUNITY
Salt Lake Community College is an
equal opportunity institution providing
education and employment opportunities
without regard to race, color, national
origin, age, sex, religion, disability or
covered veterans status. Inquiries
concerning the above, including the
application of Title VI, VII, Title IX,
Sec. 504 or the VEVRA (Veterans) of
1974, may be referred to the Salt Lake
Community College Director of Equal
Employment Opportunity, Technology
Building, Room 137, (801) 957-4561, or
Department of Education, Region VIII,
Federal Office Building, 1244 Speer Blvd.,
Suite 310, Denver, Colorado 802-3582,
(303) 844-5696.
AMERICANS WITH DISABILITIES
Salt Lake Community College embraces
both the letter and the spirit of the
American with Disabilities Act, which
in part says, "...no qualified individual
with a disability shall, by reason of such
disability, be excluded from participation
in or be denied the benefits of, the
services, programs or activities of a public
entity, or be subjected to discrimination
by any such entity..."
For information about services and
accommodations for students with
disabilities, please contact the SLCC
Disability Resource Center at:
(801) 957-4659 (Voice)
(801) 957-4646 (TTY)
For other ADA-related questions contact:
SLCC ADA Coordinator
(801) 957-4041
SLCC Human Resources Representative
(801) 957-4212
ENROLLMENT SERVICES
P.O. Box 30808, 4600 S. Redwood R oad
.O. Bo Redwood
edwoo
Lake
Salt Lake City, UT 84130-0808
957-
(801) 957 - 4111