Application forAdmission - Wayne County Community …

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STUDENT TYPESCheck all boxes that apply New Student Guest Student Virtual Learning Collaborative Returning Student Transfer Student Tech PrepWhen do you plan to enroll? Summer 20 _____ Fall 20 _____ Spring 20 _____Preferred Campus Downriver Downtown Eastern Northwest WesternPreferred Program Code ________________________________________ Associate s Certificate Selected Courses(See Insert)DegreeOnlyPRIOR ACADEMIC HISTORYList the last or current high school attended and all colleges, universities or other post-secondary educationalprograms (S) OF HIGH SCHOOL (S), COLLEGE (S) OR GED CENTERGRADUATION DATE(Attach additional sheets if necessary)MONTHDATEYEARDid you graduate from high school? Yes NoName of High SchoolCity & StateGED Yes NoDid you take Tech Prep classes in high school? Yes NoIf yes, which center?College/UniversityName of College or UniversityCity & StateSTUDENT'S SIGNATUREI certify that all information on this form is complete and accurate.

last first middle currentaddressandphonenumbers number&street p.o.b0xorapartment city state zipcode • hometelephonenumber • • mm dd y y • • • • socialsecuritynumber dateofbirth gender

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