Application for Admission - Wallace Community …

1 For Admission to Wallace Community college an applicant must provide one primary form of unexpired identification such as a driver s license, instruction permit, identification card, passport, or permanent resident card. To be admitted to Wallace Community college , applicants must submit the documentation identified above prior to registration for the first term of attendance. Which WCC Campus will you attend? Wallace Campus in Dothan Sparks Campus in Eufaula What term do you plan to enroll?

2 Fall Spring Summer Year _____ Date of Birth ____/____/_____ Social Security Number ___ ___ ___ -- ___ ___ -- ___ ___ ___ ___ PLEASE PRINT CLEARLY Last Name First Name Middle List any other names by which transcripts may be listed Current Mailing Address City State Zip County (_____) _____-_____ (_____)

3 _____-_____ _____ Home Phone Cell Phone email State of Birth County of Birth Employer Employer s Phone Indicate your educational goal. Check boxes that apply in either area A or area B below. A. Planning to enroll in general studies courses at WCC for transfer purposes.

4 (Check one) Associate in Science (AS) Associate in Arts (AA) Major:_____ _____ B. Planning to pursue a WCC AAS (non-transfer) degree or certificate program. (check one) Associate in Applied Science (AAS) Certificate (CER) Short Term Certificate (STC) Please choose one of the programs of study from page three: _____ Graduation Information Check One: High School Graduate Year of Graduation_____ GED Diploma Year of Diploma_____ _____ _____ Name of High School OR GED Test Center State Did either of your parents graduate with a 4-year degree?

5 Yes No Sex: Male Female (Optional) Ethnicity: Are you Hispanic or Latino? Yes No You may choose one or more of the race categories listed below: Black or African American Asian White American Indian or Alaska Native Hawaiian or Other Pacific Islander Citizenship: United States Citizen Resident Alien Foreign Visa Visa type :_____ Non-US Citizen.

6 Deferred Action for Childhood Arrivals _____ Country of citizenship if other than Admissions Entry Status First-time college Student (have never attended college ) Transfer Student (List colleges on reverse side) Transient Student (List college on reverse side) Audit Student Please mark ALL that apply to your military status below: Using VA Benefits? Yes No Active Duty Military Reserve/National Guard Military Dependent Veteran Name of person to notify in case of emergency: _____ Emergency Phone:_____ Office use only: Student #_____ Photo ID exp _____ Staff_____ Date_____ Application for Admission Wallace Campus in Dothan Sparks Campus in Eufaula 3.

7 Non-Resident Request for In-State Tuition I live in one of the following counties with which Wallace Community college has a reciprocal agreement: Georgia: Baker Calhoun Chattahoochee Clay Stewart Decatur Dougherty Early Marion Terrell Seminole Miller Muscogee Quitman Randolph Sumter Webster Florida: Bay Calhoun Holmes Jackson Walton Washington I or my supporting person (spouse/parent(s)) is a member of the United States Military on full-time active duty stationed in Alabama under orders for duties other than attending school.

8 I or my supporting person (spouse/parent(s)) can verify full-time permanent employment in Alabama and commence said employment within 90 days of registration. I or my supporting person (spouse/parents) is a full-time permanent employee of Wallace Community college . I or my supporting person (spouse/parents) is an accredited member of a consular staff assigned to duties in Alabama. LIST ALL COLLEGES AND UNIVERSITIES PREVIOUSLY ATTENDED Have you earned a Degree or higher? Yes No Are you on suspension at another college /University?

9 Yes No Colleges/Universities City/State Dates of Attendance Degree Earned Wallace Community college fully complies with the Family Educational Rights & Privacy Act of 1974, a federal law designed to limit the disclosure of personally identifiable information contained in education records. Except for directory information as defined in the current college catalog, the personal information that you provide on this Application for Admission will not be disclosed to a third party without your express, written consent.

10 If you would like to request non-release of directory information, please contact the Admissions and Records Office. CERTIFICATION OF ELIGIBILITY FOR IN-STATE TUITION Eligibility for in-state tuition is determined in one of three ways: LEGAL RESIDENCY, SUBSTANTIAL CONNECTIONS, or NON-RESIDENT REQUEST. Please provide information below in ONE category that qualifies you for in-state tuition. I. I certify that I am a resident of the State of Alabama: I (or my non-estranged spouse) have lived in the State of Alabama for at least 12 months immediately preceding my Application for Admission .