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Placement - Application Sample


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Placement - Application Sample

  1. 1. My 2012 ApplicationKeep this copy for your records. Do not mail.Made a mistake? Call the Recruitment Response Center at 800.342.3811, Monday - Friday, between 8:30 am and 4:30 pm (EST).Preliminary Questions SectionAre you a US Citizen? YesWill you be a freshman or transfer student? FreshmanAre you applying for the Educational Opportunity Program? YesAbout Me SectionLast Name: HensleyFirst Name: RobertMiddle Name: DanielSuffix (i.e. Jr, II):Social Security Number: 592- 31- 4068Date of Birth: 03 / 23 / 1993Gender: MaleMilitary/Veteran Status?My Ethnicity/Race Are you Hispanic/Latino? No Race: WhiteDisability Status:Is English your native language? YesHave you been convicted of a felony? NoHave you been dismissed and/or suspended from a college for disciplinary Noreasons?Former Last Name:Former First Name:My Addresses SectionAre you a New York State resident? YesIf yes, then what is your New York State county of residence? LivingstonIf yes, but for less than one year, how many months? 9Home Phone Number: ( 585 ) 969 - 0127Work Phone Number:Email Address: ralf498@gmail.comPermanent Home Mailing Address: 8253 Carney Hollow Rd Wayland , NY 14572 - 9327Temporary Mailing Address:Date after which mail should be sent to your permanent address:My Family SectionParent/Guardian Last Name: Jones-WenningerParent/Guardian First Name: GwynethParent/Guardian Suffix Name (i.e. Jr, III):
  2. 2. My 2012 ApplicationParent/Guardian Address: 8253 Carney Hollow Rd Wayland , NY 14572 - 9327Family Income Range: $15,000 - $29,999Size of Household (including applicant): 8First Alumnus/a:My Student Info SectionAre you applying for full-time or part-time study? Full-timeIndicate up to 5 student support services you would like: Improving mathematical skills Improving writing skills Developing good study techniques Personal, career or educational counseling Finding part-time jobsAre you an Adult Learner? NoMy High School SectionHigh School Name and Address: Wayland - Cohocton High School 2350 Route 63 Wayland NY 145729404Indicate your Secondary Education Status: Will GraduateDate of High School graduation, withdrawal or completion of GED:Date last Scholastic Aptitude Test (SAT) was or will be taken:Date last American College Test (ACT) was or will be taken:My Campus Selections SectionFirst Campus Genesee Community College Fall 2012 Liberal Arts & Sciences: Humanities & Social SciAre you applying for Educational Opportunity Program (EOP) at this campus? YesAre you applying for Early Action?Are you applying for Early Decsion?Do you wish campus housing? NoIf applying to this campus again, when did you first apply?Special Campus ProjectIf applying for Joint Admission, select your four-year campus choice.