| Applicant E-Mail |
Important: Enter a valid e-mail address. Correspondance will be sent to this address. |
| E-Mail:* | | |
| Applicant Information |
| First Name:* | | |
| Middle Initial: | | |
| Last Name:* | | |
| Address Line 1:* | | |
| Address Line 2: | | Apt. or Suite No. |
| City:* | | |
| State:* | | |
| Zip Code:* | | |
| Home Phone:* | | |
| Work Phone:* | | |
| Cell Phone: | | |
| Date of Birth* |  | |
| Identification Number* | | |
| What is your marital status?* | Single
Married
Divorced
Widowed
|
| Ethnic Origin: | | |
| Educational Experience |
Applicants must have all official high school, college transcripts and/or GED |
Test scores sent directly to our College. |
| High School Experience:* | | |
| College Experience:* | | |
| Employment Status |
| Employment Status:* | | |
| Residency Status |
| Legal North Carolina Resident?* | Yes
No
|
| If yes, which county: | | |
| Date moved to NC: | | (mm/dd/yyyy) |
| Driver`s License Number:* | | |
| State of Residence:* | | |
| Class Attendance |
| Day Classes: | | |
| Evening Classes: | | |
| Full Time: | | |
| Part Time: | | |
| Online Courses?* | Yes
No
|
| Enrollment:* | | |
| Educational Goals |
| Primary Goal: | | |
| High School Information |
| High School last attended:* | | |
| City/State:* | | |
| High School Graduate?* | Yes
No
|
| Graduation Date/Last Attended:* | | |
| Highest grade level: | | |
| Received GED:* | Yes
No
|
| GED School: | | |
| GED Date Received: | | (mm/dd/yyyy) |
By clicking the `Submit Application` button below, I hereby certify that all the |
information I have given is accurate to the best of my knowledge. |
| Signature:* |
| Enter first & last name |
| Reset |
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